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General NPI Number Information
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NPI Number | 1164851515
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Entity Type | Organization
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Legal Business Name | CUTLER BAY MEDICAL & DIAGNOSTIC CENTER CORP
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 20525 SW 82ND CT
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City | CUTLER BAY
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State | FL
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Zip | 33189-2632
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Country | US
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Telephone | 305-812-6875
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Fax | 786-732-0637
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Provider Business Mailing Address
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Address Line | 20525 SW 82ND CT
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City | CUTLER BAY
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State | FL
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Zip | 33189-2632
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Country | US
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Telephone | 305-812-6875
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Fax | 786-732-0637
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIRNA ESCOTO
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Credential |
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Telephone | 305-812-6875
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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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