Healthcare Provider Details

I. General information

NPI: 1679837280
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: 06/28/2012
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW 95TH ST
MIAMI FL
33147-2414
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD #136
MIAMI FL
33169-5373
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-2977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY CHEN
Title or Position: OFFICER
Credential:
Phone: 305-628-6117