Healthcare Provider Details

I. General information

NPI: 1477514651
Provider Name (Legal Business Name): MAIMONIDES MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 S US HIGHWAY 1
ROCKLEDGE FL
32955-2732
US

IV. Provider business mailing address

1295 S US HIGHWAY 1
ROCKLEDGE FL
32955-2732
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-6654
  • Fax: 321-433-1119
Mailing address:
  • Phone: 321-637-6654
  • Fax: 321-433-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLINA C SARENAS
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 321-637-6654