Healthcare Provider Details

I. General information

NPI: 1518296581
Provider Name (Legal Business Name): WESTWARD MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

IV. Provider business mailing address

286 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-1445
  • Fax: 305-884-1451
Mailing address:
  • Phone: 305-884-1445
  • Fax: 305-884-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMA35823
License Number StateFL

VIII. Authorized Official

Name: MARIO DE LA ROSA
Title or Position: PRESIDENT
Credential: M.T
Phone: 305-884-1445