Healthcare Provider Details

I. General information

NPI: 1134717036
Provider Name (Legal Business Name): ASCENCION MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 NW 67 AVE
MIAMI FL
33144
US

IV. Provider business mailing address

7440 N KENDALL DR APT 3113
MIAMI FL
33156-8073
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-0791
  • Fax:
Mailing address:
  • Phone: 305-807-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GUIDO LOPEZ
Title or Position: ADMINISTRATOR
Credential: ARNP
Phone: 786-353-2573