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General NPI Number Information
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NPI Number | 1164565685
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Entity Type | Organization
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Legal Business Name | MADRINA MEDICAL CENTER, INC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE STE 430
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City | DORAL
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State | FL
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Zip | 33166-6599
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Country | US
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Telephone | 786-235-7143
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE STE 430
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City | DORAL
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State | FL
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Zip | 33166-6599
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Country | US
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Telephone | 786-235-7143
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARIDAD DOMINGUEZ
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Credential |
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Telephone | 786-331-7769
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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 | 7771
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License Number State | FL
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