Healthcare Provider Details

I. General information

NPI: 1881072650
Provider Name (Legal Business Name): FMMEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST SUITE 465
MIAMI FL
33173-3012
US

IV. Provider business mailing address

10300 SW 72ND ST SUITE 465
MIAMI FL
33173-3012
US

V. Phone/Fax

Practice location:
  • Phone: 305-302-7121
  • Fax: 305-549-8241
Mailing address:
  • Phone: 305-302-7121
  • Fax: 305-549-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DENIA PELLITERO
Title or Position: OWNER
Credential:
Phone: 305-302-7121