Healthcare Provider Details

I. General information

NPI: 1851407522
Provider Name (Legal Business Name): PALMETTO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-874-2258
  • Fax: 305-874-2259
Mailing address:
  • Phone: 305-874-2258
  • Fax: 305-874-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC6911
License Number StateFL

VIII. Authorized Official

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