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General NPI Number Information
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NPI Number | 1295474575
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Entity Type | Organization
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Legal Business Name | PENATE MEDICAL CENTER 1 LLC
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 14788 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33185-4070
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Country | US
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Telephone | 786-272-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 SW 117TH AVE STE 112
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City | MIAMI
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State | FL
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Zip | 33183-4825
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Country | US
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Telephone | 786-272-9170
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | CLARA PENATE
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Credential |
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Telephone | 786-436-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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