Healthcare Provider Details

I. General information

NPI: 1124698337
Provider Name (Legal Business Name): LA COLONIA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 SW 137TH AVE
KENDALL FL
33183-1105
US

IV. Provider business mailing address

167 W 23RD ST
HIALEAH FL
33010-2211
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-3312
  • Fax: 786-360-2327
Mailing address:
  • Phone: 305-823-3312
  • Fax: 786-360-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YENIN ACEVEDO
Title or Position: PRESIDENT
Credential: FMG
Phone: 305-608-1082