Healthcare Provider Details

I. General information

NPI: 1801012737
Provider Name (Legal Business Name): E&L MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 NW 36TH ST SUITE 101
VIRGINIA GARDENS FL
33166-6978
US

IV. Provider business mailing address

6555 NW 36TH ST SUITE 101
VIRGINIA GARDENS FL
33166-6978
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-7303
  • Fax: 305-871-7336
Mailing address:
  • Phone: 305-871-7303
  • Fax: 305-871-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCC6302
License Number StateFL

VIII. Authorized Official

Name: MRS. GLEYDIS MARRERO
Title or Position: OFFICEMANAGER
Credential:
Phone: 305-871-7303