Healthcare Provider Details

I. General information

NPI: 1730383480
Provider Name (Legal Business Name): MEDCHOICE OF OPALOCKA L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 OPA LOCKA BLVD
OPA LOCKA FL
33054-4226
US

IV. Provider business mailing address

1980 OPA LOCKA BLVD
OPA LOCKA FL
33054-4226
US

V. Phone/Fax

Practice location:
  • Phone: 305-398-0807
  • Fax: 305-269-8825
Mailing address:
  • Phone: 305-405-8800
  • Fax: 305-685-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. EVA DIAZ
Title or Position: OFFICE MGR
Credential: RN
Phone: 305-398-0807