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General NPI Number Information
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NPI Number | 1134160179
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Entity Type | Organization
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Legal Business Name | METRO MED OF HIALEAH INC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 1840 W 49TH ST SUITE 103
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City | HIALEAH
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State | FL
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Zip | 33012-2942
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Country | US
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Telephone | 305-362-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 W 49TH ST SUITE 103
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City | HIALEAH
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State | FL
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Zip | 33012-2942
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Country | US
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Telephone | 305-362-5588
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAMARIS E OLIVA
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Credential |
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Telephone | 305-362-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | HCC5458
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License Number State | FL
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