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General NPI Number Information
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NPI Number | 1215981618
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Entity Type | Organization
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Legal Business Name | DOCTOR'S MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1272 NW 119TH ST
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City | MIAMI
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State | FL
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Zip | 33167-3232
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Country | US
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Telephone | 305-685-5688
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Fax | 305-687-1817
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Provider Business Mailing Address
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Address Line | 5605 NW 82ND AVE
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City | DORAL
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State | FL
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Zip | 33166-4000
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Country | US
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Telephone | 305-685-5688
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Fax | 786-618-5307
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | VENTURA DE PAZ
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Credential | PA
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Telephone | 305-685-5688
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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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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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