Healthcare Provider Details

I. General information

NPI: 1497423693
Provider Name (Legal Business Name): CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OPA LOCKA BLVD
OPA LOCKA FL
33054-3528
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 786-535-7200
  • Fax: 786-535-7294
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: OWNER
Credential:
Phone: 305-628-6117