Healthcare Provider Details

I. General information

NPI: 1366752131
Provider Name (Legal Business Name): LSL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 NW 42ND AVE SUITE 433
MIAMI FL
33126-5541
US

IV. Provider business mailing address

782 NW 42ND AVE SUITE 433
MIAMI FL
33126-5541
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-8229
  • Fax:
Mailing address:
  • Phone: 305-443-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC8617
License Number StateFL

VIII. Authorized Official

Name: ALEXANDER GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 305-443-8229