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General NPI Number Information
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NPI Number | 1528445806
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Entity Type | Organization
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Legal Business Name | WHITE DIAMOND MEDICAL CENTER CORP
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE 569
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 786-208-7224
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Fax | 786-364-0192
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE 569
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 786-208-7224
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Fax | 786-364-0192
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Authorized Official
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Title or Position | OWNER
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Name | JOSE M DE LA MONEDA
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Credential |
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Telephone | 786-208-7224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | FL
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