Healthcare Provider Details

I. General information

NPI: 1942254495
Provider Name (Legal Business Name): MEDICAL GENERAL ASSISTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 NW 72ND AVE SUITE 213 A&B
MEDLEY FL
33166-2227
US

IV. Provider business mailing address

7911 NW 72ND AVE SUITE 213 A&B
MEDLEY FL
33166-2227
US

V. Phone/Fax

Practice location:
  • Phone: 305-883-7511
  • Fax:
Mailing address:
  • Phone: 305-883-7511
  • 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: YAMILET CARDENAS
Title or Position: PRESIDENT
Credential:
Phone: 305-883-7511