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General NPI Number Information
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NPI Number | 1700135928
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Entity Type | Organization
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Legal Business Name | NAZARE MEDICAL CENTER, CORP
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 55 W 29TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5739
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Country | US
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Telephone | 786-332-4931
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Fax | 786-334-6403
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Provider Business Mailing Address
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Address Line | 55 W 29TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5739
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Country | US
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Telephone | 786-332-4931
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Fax | 786-334-6403
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Authorized Official
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Title or Position | OWNER
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Name | DAILY V YBARGOLLIN
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Credential |
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Telephone | 305-123-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN9214684
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License Number State | FL
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