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General NPI Number Information
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NPI Number | 1497191563
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Entity Type | Organization
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Legal Business Name | MED-CLINIC INC.
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 10800 NW 58 ST
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone | 305-477-4475
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Fax | 305-477-4487
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Provider Business Mailing Address
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Address Line | 10800 NW 58TH ST
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City | DORAL
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State | FL
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Zip | 33178-2854
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Country | US
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Telephone | 305-477-4475
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Fax | 305-477-4487
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL LOPEZ DIAZ
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Credential | MD
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Telephone | 305-477-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 8690
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License Number State | FL
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