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General NPI Number Information
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NPI Number | 1750070686
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Entity Type | Organization
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Legal Business Name | KIM MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE STE 304
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City | SWEETWATER
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State | FL
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Zip | 33172-2742
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Country | US
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Telephone | 305-456-3190
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 NW 107TH AVE STE 304
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City | SWEETWATER
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State | FL
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Zip | 33172-2742
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Country | US
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Telephone | 305-456-3190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAVIER DUARTE
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Credential |
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Telephone | 305-746-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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