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General NPI Number Information
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NPI Number | 1346251048
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Entity Type | Organization
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Legal Business Name | SELECTA MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1490 W 49 PL SUITE 210
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-817-9151
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Fax | 305-817-9157
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Provider Business Mailing Address
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Address Line | 1490 W 49 PL SUITE 210
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-817-9151
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Fax | 305-817-9157
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARA L MACARENO
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Credential |
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Telephone | 786-325-4118
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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 | HCC5024
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License Number State | FL
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