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General NPI Number Information
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NPI Number | 1629652995
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Entity Type | Organization
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Legal Business Name | MD ACCESS MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 5511 S CONGRESS AVE STE 101
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City | ATLANTIS
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State | FL
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Zip | 33462-1140
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Country | US
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Telephone | 786-256-7736
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Fax |
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Provider Business Mailing Address
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Address Line | 22031 SW 127TH AVE
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City | MIAMI
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State | FL
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Zip | 33170-2603
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Country | US
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Telephone | 786-256-7736
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. OSVALDO A LOPEZ
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Credential | ARNP
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Telephone | 786-256-7736
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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