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General NPI Number Information
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NPI Number | 1376784801
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Entity Type | Organization
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Legal Business Name | KENDALL FAMILY MEDICAL CENTER, CORP.
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 11760 SW 40TH ST STE 112
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City | MIAMI
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State | FL
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Zip | 33175-3589
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Country | US
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Telephone | 305-552-6969
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Fax | 305-552-6775
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Provider Business Mailing Address
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Address Line | 11760 SW 40TH ST STE 112
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City | MIAMI
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State | FL
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Zip | 33175-3589
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Country | US
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Telephone | 305-552-6969
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Fax | 305-552-6775
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JORGE ACOSTA
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Credential |
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Telephone | 305-485-7979
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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 |
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License Number State |
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