Healthcare Provider Details

I. General information

NPI: 1811196785
Provider Name (Legal Business Name): MEDCHOICE OF AIRPORT, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 NW 7TH ST
MIAMI FL
33125-4069
US

IV. Provider business mailing address

PO BOX 141799
CORAL GABLES FL
33114-1799
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-3311
  • Fax: 305-643-8604
Mailing address:
  • Phone: 305-643-3311
  • Fax: 305-643-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA M PALACIO
Title or Position: OFFICE MGR
Credential:
Phone: 305-398-0807