Healthcare Provider Details

I. General information

NPI: 1407170004
Provider Name (Legal Business Name): WESTLAND SOUTH MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 SW 107TH AVE
MIAMI FL
33165-3633
US

IV. Provider business mailing address

3410 SW 107TH AVE
MIAMI FL
33165-3633
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-1997
  • Fax: 305-559-1971
Mailing address:
  • Phone: 305-559-1997
  • Fax: 305-559-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC5750
License Number StateFL

VIII. Authorized Official

Name: MRS. CINDY MARIA PEREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-559-1997