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General NPI Number Information
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NPI Number | 1609683010
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Entity Type | Organization
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Legal Business Name | OTANTIK MEDICAL CENTER
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 170 NW 189TH TER SUITE C
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4004
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Country | US
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Telephone | 305-650-1695
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Fax | 305-675-2297
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Provider Business Mailing Address
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Address Line | 170 NW 189 TER SUITE C
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4004
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Country | US
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Telephone | 305-650-1695
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Fax | 305-675-2297
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Authorized Official
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Title or Position | CEO
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Name | FREDO C JEAN FRANCOIS
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Credential |
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Telephone | 954-882-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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