Healthcare Provider Details

I. General information

NPI: 1740872811
Provider Name (Legal Business Name): OCEAN EAST MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 1900 W DIXIE HWY
MIAMI FL
33161
US

IV. Provider business mailing address

28810 SW 154 AVE
HOMESTAED FL
33033-2543
US

V. Phone/Fax

Practice location:
  • Phone: 786-747-4970
  • Fax: 305-508-6680
Mailing address:
  • Phone: 786-730-8268
  • Fax: 305-508-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ELIUX VELAZQUEZ
Title or Position: OWNER
Credential:
Phone: 786-730-8268