Healthcare Provider Details

I. General information

NPI: 1801279716
Provider Name (Legal Business Name): INTERMED MEDICAL RESEARCH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13055 SW 42ND ST SUITE: 103
MIAMI FL
33175-3406
US

IV. Provider business mailing address

13055 SW 42ND ST SUITE: 103
MIAMI FL
33175-3406
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-6176
  • Fax:
Mailing address:
  • Phone: 305-351-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUZ MARIA MELGAREJO
Title or Position: OWNER
Credential:
Phone: 305-351-6176