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General NPI Number Information
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NPI Number | 1548359532
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Entity Type | Organization
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Legal Business Name | IDEAL MEDICAL CENTER OF HIALEAH, INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3805 W 20 AVE SUITE 105
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-557-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 11782 SW 92 TER
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City | MIAMI
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State | FL
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Zip | 33186
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Country | US
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Telephone | 305-271-7464
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Fax |
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Authorized Official
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Title or Position | COO
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Name | OCTAVIO ALEXIS BRAVO
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Credential |
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Telephone | 305-557-2277
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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 | HCC6717
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License Number State | FL
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