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General NPI Number Information
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NPI Number | 1710227988
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Entity Type | Organization
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Legal Business Name | MG MEDICAL FACILITY INC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 1821 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3825
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Country | US
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Telephone | 954-432-8856
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Fax | 954-432-8955
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Provider Business Mailing Address
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Address Line | 1821 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3825
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Country | US
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Telephone | 954-432-8856
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Fax | 954-432-8955
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARIA DE JESUS RODRIGUEZ
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Credential |
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Telephone | 954-432-8856
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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 | HCC6432
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License Number State | FL
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