Healthcare Provider Details

I. General information

NPI: 1871883561
Provider Name (Legal Business Name): CIVIC MEDICAL CENTER OF SOUTH DADE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26085 S DIXIE HWY
NARANJA FL
33032-6613
US

IV. Provider business mailing address

PO BOX 441206
MIAMI FL
33144-1206
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-2221
  • Fax: 305-247-8349
Mailing address:
  • Phone: 305-246-2221
  • Fax: 305-247-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO L REGALADO
Title or Position: PRESIDENT
Credential:
Phone: 305-398-0807