Healthcare Provider Details

I. General information

NPI: 1801405170
Provider Name (Legal Business Name): BLUE MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 SW 24TH ST STE 129
MIAMI FL
33155-6553
US

IV. Provider business mailing address

7805 SW 24TH ST STE 129
MIAMI FL
33155-6553
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-8580
  • Fax: 305-364-5438
Mailing address:
  • Phone: 305-400-8580
  • Fax: 305-364-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL LIBERA
Title or Position: PRESIDENT
Credential:
Phone: 305-400-8580