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General NPI Number Information
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NPI Number | 1710376389
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Entity Type | Organization
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Legal Business Name | EARLY TIME MEDICAL CENTER INC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 1275 W 47TH PL STE 305
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City | HIALEAH
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State | FL
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Zip | 33012-3447
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Country | US
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Telephone | 786-409-2495
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Fax | 786-409-2472
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Provider Business Mailing Address
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Address Line | 1275 W 47TH PL STE 305
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City | HIALEAH
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State | FL
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Zip | 33012-3447
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Country | US
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Telephone | 786-409-2495
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Fax | 786-409-2472
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ABEL RIVERA LLANES
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Credential |
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Telephone | 786-762-3907
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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 | ME55442
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License Number State | FL
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