Healthcare Provider Details

I. General information

NPI: 1003338138
Provider Name (Legal Business Name): WK MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13304 SW 128TH ST
MIAMI FL
33186-5899
US

IV. Provider business mailing address

13304 SW 128TH ST
MIAMI FL
33186-5899
US

V. Phone/Fax

Practice location:
  • Phone: 54-249-0603
  • Fax: 305-363-4412
Mailing address:
  • Phone: 786-227-6498
  • Fax: 305-570-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDEL QUINTERO
Title or Position: PRESIDENT
Credential:
Phone: 305-424-9060