Healthcare Provider Details

I. General information

NPI: 1205415197
Provider Name (Legal Business Name): LUQUE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13205 SW 137TH AVE STE 128
MIAMI FL
33186-5334
US

IV. Provider business mailing address

13205 SW 137TH AVE STE 128
MIAMI FL
33186-5334
US

V. Phone/Fax

Practice location:
  • Phone: 786-362-2881
  • Fax:
Mailing address:
  • Phone: 786-362-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLGA M GUTIERREZ
Title or Position: CEO
Credential:
Phone: 786-362-2818