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General NPI Number Information
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NPI Number | 1265864706
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Entity Type | Organization
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Legal Business Name | TRISQUEL MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE SUITE 215
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City | DORAL
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State | FL
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Zip | 33172-2732
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Country | US
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Telephone | 305-468-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 NW 107TH AVE STE 215
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City | DORAL
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State | FL
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Zip | 33172-2741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MEYDEL RANGEL
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Credential |
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Telephone | 305-468-1485
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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 | MA65882
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License Number State | FL
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