Healthcare Provider Details

I. General information

NPI: 1417528829
Provider Name (Legal Business Name): HEALTHRA MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8512 SW 8TH ST
MIAMI FL
33144-4053
US

IV. Provider business mailing address

8512 SW 8TH ST
MIAMI FL
33144-4053
US

V. Phone/Fax

Practice location:
  • Phone: 305-239-7477
  • Fax: 786-633-5944
Mailing address:
  • Phone: 305-239-7477
  • Fax: 786-633-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS RODRIGUEZ
Title or Position: CEO/OWNER
Credential:
Phone: 786-452-6858