Healthcare Provider Details

I. General information

NPI: 1083874275
Provider Name (Legal Business Name): IFA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 SW 107TH AVE SUITE 201
MIAMI FL
33165-7344
US

IV. Provider business mailing address

1695 SW 107TH AVE SUITE 201
MIAMI FL
33165-7344
US

V. Phone/Fax

Practice location:
  • Phone: 305-207-4443
  • Fax: 305-207-4442
Mailing address:
  • Phone: 305-207-4443
  • Fax: 305-207-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIEZER GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-207-4443