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General NPI Number Information
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NPI Number | 1104282011
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Entity Type | Organization
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Legal Business Name | GARDEN MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 2800 W 84TH ST UNIT 11
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City | HIALEAH
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State | FL
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Zip | 33018-4922
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Country | US
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Telephone | 786-409-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 W 84TH ST UNIT 11
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City | HIALEAH
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State | FL
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Zip | 33018-4922
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Country | US
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Telephone | 786-409-4044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLEN LOPEZ
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Credential |
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Telephone | 305-502-3980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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