Healthcare Provider Details

I. General information

NPI: 1952849820
Provider Name (Legal Business Name): MEDICA SAN MIGUEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 6 NORTE NO 132 ENTRE 5A Y 10A AVS COL CENTRO
COZUMEL QUINTANA ROO
77600
MX

IV. Provider business mailing address

PO BOX 11577
FORT LAUDERDALE FL
33339-1577
US

V. Phone/Fax

Practice location:
  • Phone: 954-903-7445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIO ROSADO
Title or Position: MANAGER
Credential:
Phone: 954-903-7445