Healthcare Provider Details

I. General information

NPI: 1114272713
Provider Name (Legal Business Name): LOS ABUELOS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 SW 157TH AVE UNIT 10
MIAMI FL
33196-1157
US

IV. Provider business mailing address

8901 SW 157TH AVE UNIT 10
MIAMI FL
33196-1157
US

V. Phone/Fax

Practice location:
  • Phone: 305-382-0111
  • Fax: 786-955-2222
Mailing address:
  • Phone: 305-382-0111
  • Fax: 786-955-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS HERNANDO PINZON
Title or Position: PRESIDENT
Credential: RN
Phone: 786-234-6513