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General NPI Number Information
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NPI Number | 1114342979
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Entity Type | Organization
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Legal Business Name | HEALTHSUN MEDICAL CENTER CORP
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 13903 NW 67TH AVE STE 420
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2939
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Country | US
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Telephone | 786-420-5503
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Fax | 786-420-5504
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Provider Business Mailing Address
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Address Line | 13903 NW 67TH AVE STE 420
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2939
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Country | US
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Telephone | 786-420-5503
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Fax | 786-420-5504
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BLANCA N GONZALEZ
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Credential | MD
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Telephone | 786-420-5503
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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 | ME106369
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License Number State | FL
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