Healthcare Provider Details

I. General information

NPI: 1831633841
Provider Name (Legal Business Name): DIAMOND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 SW 24TH ST SUITE 214
MIAMI FL
33165-2060
US

IV. Provider business mailing address

8890 SW 24TH ST SUITE 214
MIAMI FL
33165-2060
US

V. Phone/Fax

Practice location:
  • Phone: 305-982-8578
  • Fax: 305-982-8765
Mailing address:
  • Phone: 305-982-8578
  • Fax: 305-982-8765

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 Number
License Number State

VIII. Authorized Official

Name: LORENZO SANSO
Title or Position: OWNER
Credential:
Phone: 305-982-8578