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General NPI Number Information
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NPI Number | 1770204141
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Entity Type | Organization
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Legal Business Name | ALTIUS MEDICAL CENTER LLC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 14221 SW 120TH ST STE 129
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City | MIAMI
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State | FL
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Zip | 33186-7463
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Country | US
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Telephone | 786-292-9650
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Fax | 786-420-3240
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Provider Business Mailing Address
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Address Line | 14221 SW 120TH ST STE 129
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City | MIAMI
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State | FL
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Zip | 33186-7463
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Country | US
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Telephone | 786-292-9650
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Fax | 786-420-3240
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. ALIAN HERNANDEZ LOPEZ
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Credential | MD
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Telephone | 305-988-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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