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General NPI Number Information
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NPI Number | 1639467095
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER OF DADE, INC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 920 SW 82ND AVE STE A
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City | MIAMI
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State | FL
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Zip | 33144-4269
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Country | US
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Telephone | 305-262-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 920 SW 82ND AVE STE A
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City | MIAMI
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State | FL
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Zip | 33144-4269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISSET PRIETO PINO
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Credential |
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Telephone | 305-262-9418
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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 | HCC9296
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License Number State | FL
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