Healthcare Provider Details

I. General information

NPI: 1619521010
Provider Name (Legal Business Name): KETER MEDICAL CENTER & SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 NW 7TH ST STE 102
MIAMI FL
33126-4107
US

IV. Provider business mailing address

8000 NW 7TH ST STE 102
MIAMI FL
33126-4107
US

V. Phone/Fax

Practice location:
  • Phone: 786-290-6828
  • Fax:
Mailing address:
  • Phone: 786-290-6828
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RUBER LABORDE
Title or Position: OWNER
Credential: APRN
Phone: 786-290-6828