Healthcare Provider Details

I. General information

NPI: 1700465226
Provider Name (Legal Business Name): LEGACY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6741 SW 24TH ST STE 46
MIAMI FL
33155-1767
US

IV. Provider business mailing address

6741 SW 24TH ST STE 46
MIAMI FL
33155-1767
US

V. Phone/Fax

Practice location:
  • Phone: 786-427-7059
  • Fax:
Mailing address:
  • Phone: 786-427-7059
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO CUBA
Title or Position: CEO
Credential:
Phone: 786-263-3100