Healthcare Provider Details

I. General information

NPI: 1902857378
Provider Name (Legal Business Name): MD MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 SW 8TH ST SUITE 104
MIAMI FL
33144-4263
US

IV. Provider business mailing address

8150 SW 8TH ST SUITE 104
MIAMI FL
33144-4263
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-2707
  • Fax: 954-987-1355
Mailing address:
  • Phone: 305-267-2707
  • Fax: 954-987-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL NIETO
Title or Position: PRESIDENT
Credential:
Phone: 305-267-2707