Healthcare Provider Details

I. General information

NPI: 1659888741
Provider Name (Legal Business Name): DEDICATED SENIOR MEDICAL CENTER OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 ULMERTON RD
LARGO FL
33771
US

IV. Provider business mailing address

1395 NW 167TH STREET
MIAMI GARDENS FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-628-6117
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND JIMENEZ
Title or Position: DIRECTOR OF CLIENT SERVICES
Credential:
Phone: 305-628-6117