Healthcare Provider Details

I. General information

NPI: 1548095011
Provider Name (Legal Business Name): DALIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 SW 120TH ST STE 126A
MIAMI FL
33186-7463
US

IV. Provider business mailing address

14221 SW 120TH ST STE 126A
MIAMI FL
33186-7463
US

V. Phone/Fax

Practice location:
  • Phone: 786-577-3427
  • Fax: 305-402-3728
Mailing address:
  • Phone: 786-577-3427
  • Fax: 305-402-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAXIMILIAN RAY VALDES
Title or Position: OWNER
Credential:
Phone: 305-282-9411