Healthcare Provider Details

I. General information

NPI: 1396596797
Provider Name (Legal Business Name): MC PULMONARY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 SW 26TH ST
MIAMI FL
33165-2301
US

IV. Provider business mailing address

10925 SW 26TH ST
MIAMI FL
33165-2301
US

V. Phone/Fax

Practice location:
  • Phone: 305-799-5526
  • Fax: 305-404-2340
Mailing address:
  • Phone: 305-799-5526
  • Fax: 305-404-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE A GARCIA
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 305-606-0337