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General NPI Number Information
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NPI Number | 1376012864
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Entity Type | Organization
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Legal Business Name | CONSALUD MEDICAL CENTER LLC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 4160 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-5853
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Country | US
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Telephone | 305-725-7653
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-5853
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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 | PRACTICE MANAGER
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Name | MRS. ISABEL CLARK
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Credential |
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Telephone | 305-725-7653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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