=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356672711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCH URGENT CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2010
-----------------------------------------------------
Last Update Date | 01/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 NW 79TH AVE SUITE 520
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-320-3292
-----------------------------------------------------
Fax | 305-436-5554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3900 NW 79TH AVE SUITE 520
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-320-3292
-----------------------------------------------------
Fax | 305-436-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUAN G CAMAYD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 786-320-3292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | ME81667
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------