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General NPI Number Information
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NPI Number | 1174555411
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Entity Type | Organization
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Legal Business Name | CLINIC CENTER INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 3800 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4126
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Country | US
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Telephone | 305-557-7777
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Fax | 305-557-6352
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Provider Business Mailing Address
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Address Line | 3800 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4126
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Country | US
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Telephone | 305-557-7777
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Fax | 305-557-6352
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANIBAL PEREZ DE GRACIA
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Credential |
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Telephone | 305-557-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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