Healthcare Provider Details

I. General information

NPI: 1285177501
Provider Name (Legal Business Name): LAS AMERICAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 SW 26TH ST STE G10
MIAMI FL
33175-2471
US

IV. Provider business mailing address

11865 SW 26TH ST STE G10
MIAMI FL
33175-2471
US

V. Phone/Fax

Practice location:
  • Phone: 786-452-0663
  • Fax: 786-452-0660
Mailing address:
  • Phone: 786-452-0663
  • Fax: 786-452-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. MARTA ROSA FERNANDEZ
Title or Position: MGR/CEO
Credential: MD
Phone: 305-608-0524