Healthcare Provider Details

I. General information

NPI: 1194541821
Provider Name (Legal Business Name): RETREAT MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W FLAGLER ST STE 300
MIAMI FL
33135-1915
US

IV. Provider business mailing address

1818 W FLAGLER ST STE 300
MIAMI FL
33135-1915
US

V. Phone/Fax

Practice location:
  • Phone: 786-755-2891
  • Fax: 561-363-3684
Mailing address:
  • Phone: 786-755-2891
  • Fax: 561-363-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROLANDO PEREZ HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 786-755-2891