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General NPI Number Information
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NPI Number | 1578635983
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Entity Type | Organization
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Legal Business Name | MALBERTA MEDICAL CENTER, INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE SUITE 201
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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 | 786-313-3314
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Fax | 786-313-3315
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE SUITE 201
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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 | 786-313-3314
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Fax | 786-313-3315
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Authorized Official
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Title or Position | PRESIDENT
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Name | TANIA RODRIGUEZ
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Credential |
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Telephone | 786-313-3314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 68-6719
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License Number State | FL
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