=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598541807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EGG HEALTH CENTER CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6450 W 21ST CT STE 201
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-3942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-497-5146
-----------------------------------------------------
Fax | 305-847-2492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6450 W 21ST CT STE 201
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-3942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-497-5146
-----------------------------------------------------
Fax | 305-847-2492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ELIOSDANIS GALAN GARCIA
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 305-497-5146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------