Healthcare Provider Details

I. General information

NPI: 1053684530
Provider Name (Legal Business Name): SILVERLAND MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 SW 68TH AVE
MIAMI FL
33144-3632
US

IV. Provider business mailing address

704 SW 68TH AVE
MIAMI FL
33144-3632
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-1997
  • Fax: 305-825-1991
Mailing address:
  • Phone: 305-825-1997
  • Fax: 305-825-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC9187
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY PEREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-825-1997