Healthcare Provider Details

I. General information

NPI: 1740697325
Provider Name (Legal Business Name): DE CESPEDES MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4424
US

IV. Provider business mailing address

9833 E HIBISCUS ST UNIT 571136
MIAMI FL
33257-5075
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-8887
  • Fax: 954-432-8808
Mailing address:
  • Phone: 954-432-8887
  • Fax: 954-432-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME62701
License Number StateFL

VIII. Authorized Official

Name: KARLA CRISTINA DE CESPEDES
Title or Position: OWNER
Credential:
Phone: 954-432-8887