Healthcare Provider Details

I. General information

NPI: 1275995052
Provider Name (Legal Business Name): ADYAM MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 SW 8TH ST SUITE 306
MIAMI FL
33135-4924
US

IV. Provider business mailing address

2260 SW 8TH ST SUITE 306
MIAMI FL
33135-4924
US

V. Phone/Fax

Practice location:
  • Phone: 786-760-8084
  • Fax: 305-914-4327
Mailing address:
  • Phone: 786-760-8084
  • Fax: 305-914-4327

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 State

VIII. Authorized Official

Name: NAYDA HERNANDEZ
Title or Position: PRESIDENT
Credential: MA
Phone: 786-760-8084