Healthcare Provider Details

I. General information

NPI: 1336739432
Provider Name (Legal Business Name): LA CLINICA DEL PUEBLO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SUNSET DR STE 380
MIAMI FL
33173-3020
US

IV. Provider business mailing address

10300 SUNSET DR STE 380
MIAMI FL
33173-3020
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-5245
  • Fax: 305-541-5246
Mailing address:
  • Phone: 305-418-0580
  • Fax: 305-402-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MASIEL MOREIRA
Title or Position: OWNER
Credential:
Phone: 786-515-3156