=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790877850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C-N MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 01/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7231 SW 24TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-646-1375
-----------------------------------------------------
Fax | 305-646-1355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7231 SW 24TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-646-1375
-----------------------------------------------------
Fax | 305-646-1355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CARLOS RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-646-1375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------