=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275116634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMEDA MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2021
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7855 NW 12TH ST STE 117
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-603-9846
-----------------------------------------------------
Fax | 305-603-9847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7855 NW 12TH ST STE 117
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-603-9846
-----------------------------------------------------
Fax | 305-603-9847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ORLEY MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-603-9846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------