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General NPI Number Information
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NPI Number | 1578919759
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Entity Type | Organization
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Legal Business Name | DELACALLE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 10775 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7043
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Country | US
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Telephone | 305-321-5927
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Fax | 305-360-4217
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Provider Business Mailing Address
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Address Line | 10775 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7043
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Country | US
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Telephone | 305-321-5927
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Fax | 305-360-4217
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. KARINA MARIA LOBAINA
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Credential | DDS
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Telephone | 786-486-9761
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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 | ME90679
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DN21153
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License Number State | FL
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