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General NPI Number Information
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NPI Number | 1093093726
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Entity Type | Organization
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Legal Business Name | THE MEDICAL CITY LLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 3595 W 20TH AVE STE 145
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City | HIALEAH
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State | FL
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Zip | 33012-4537
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Country | US
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Telephone | 305-557-4424
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Fax | 305-557-4426
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Provider Business Mailing Address
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Address Line | 3595 W 20TH AVE SUITE 145
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City | HIALEAH
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State | FL
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Zip | 33012-4533
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Country | US
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Telephone | 786-422-6821
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Fax | 786-422-6855
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILFRED BRACERAS
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Credential |
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Telephone | 308-889-5332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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