Healthcare Provider Details

I. General information

NPI: 1336850932
Provider Name (Legal Business Name): FACILITY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 57TH AVE STE 235
MIAMI FL
33126-2072
US

IV. Provider business mailing address

701 NW 57TH AVE STE 235
MIAMI FL
33126-2072
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-5887
  • Fax: 786-388-5432
Mailing address:
  • Phone: 786-388-5887
  • Fax: 786-388-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: WALDO ALBERTO
Title or Position: PRESIDENT
Credential: OWNER
Phone: 786-388-5887