Healthcare Provider Details

I. General information

NPI: 1790374056
Provider Name (Legal Business Name): MEDICAL CENTER INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 SHERIDAN ST
HOLLYWOOD FL
33021-3244
US

IV. Provider business mailing address

1500 N UNIVERSITY DR STE 100
CORAL SPRINGS FL
33071-6071
US

V. Phone/Fax

Practice location:
  • Phone: 954-251-2381
  • Fax: 954-251-2365
Mailing address:
  • Phone: 954-251-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILSON IZQUIERDO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-780-0009