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General NPI Number Information
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NPI Number | 1477794089
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Entity Type | Organization
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Legal Business Name | NLC PLATINUM SERVICE INC
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 4410 W 16TH AVE # 5-244
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City | HIALEAH
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State | FL
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Zip | 33012-7100
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Country | US
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Telephone | 305-910-7424
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 W 16TH AVE # 5-244
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City | HIALEAH
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State | FL
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Zip | 33012-7100
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Country | US
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Telephone | 305-910-7424
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NOEL LEAL CUBELA
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Credential |
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Telephone | 305-910-7424
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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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