Healthcare Provider Details

I. General information

NPI: 1063411874
Provider Name (Legal Business Name): MIAMI BEACH COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ALTON RD
MIAMI BEACH FL
33139-5504
US

IV. Provider business mailing address

11645 BISCAYNE BLVD STE 207
MIAMI FL
33181-3138
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-8835
  • Fax: 305-994-0054
Mailing address:
  • Phone: 305-538-8835
  • Fax: 305-994-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LIZEL V GONZALEZ
Title or Position: CHIEF HUMAN RESOURCE OFFICER
Credential: ESQ.
Phone: 305-538-8835