Healthcare Provider Details

I. General information

NPI: 1114988151
Provider Name (Legal Business Name): PATAKY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12781 SW 42ND ST SUITE G
MIAMI FL
33175-3437
US

IV. Provider business mailing address

12781 SW 42ND ST SUITE G
MIAMI FL
33175-3437
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-2220
  • Fax: 305-553-9753
Mailing address:
  • Phone: 305-553-2220
  • Fax: 305-553-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHCC10449
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC10449
License Number StateFL

VIII. Authorized Official

Name: CARMEN ZILIA OLIVA
Title or Position: PRESIDENT
Credential: LPN
Phone: 305-553-2220