Healthcare Provider Details

I. General information

NPI: 1427353606
Provider Name (Legal Business Name): LAS BRISAS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 NW 22ND AVE 31
MIAMI FL
33125-2738
US

IV. Provider business mailing address

1131 NW 22ND AVE 31
MIAMI FL
33125-2738
US

V. Phone/Fax

Practice location:
  • Phone: 786-436-0419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE GARZON
Title or Position: MANAGER
Credential:
Phone: 786-436-0419