Healthcare Provider Details

I. General information

NPI: 1578992624
Provider Name (Legal Business Name): CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14261 SW 120TH STREET SUITE 112
MIAMI FL
33186
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5742
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-1302
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME88821
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY CHEN
Title or Position: CHIEF OPERATION OFFICER
Credential:
Phone: 305-628-6117