Healthcare Provider Details

I. General information

NPI: 1831142363
Provider Name (Legal Business Name): PALMETTO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NW 36TH ST SUITE 414
VIRGINIA GARDENS FL
33166-6959
US

IV. Provider business mailing address

6501 NW 36TH ST SUITE 414
VIRGINIA GARDENS FL
33166-6959
US

V. Phone/Fax

Practice location:
  • Phone: 305-874-2258
  • Fax:
Mailing address:
  • Phone: 305-874-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FELIPE AGUILAR
Title or Position: PRESIDENT
Credential:
Phone: 305-874-2258