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General NPI Number Information
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NPI Number | 1811197114
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Entity Type | Organization
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Legal Business Name | MARINA LAKES MEDICAL CENTER CORP
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 4960 SW 72ND AVE SUITE 304
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City | MIAMI
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State | FL
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Zip | 33155-5544
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Country | US
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Telephone | 305-740-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 SW 72ND AVE SUITE 304
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City | MIAMI
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State | FL
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Zip | 33155-5544
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Country | US
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Telephone | 305-740-9889
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOLANDA DRIGGS
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Credential |
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Telephone | 786-277-5669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC7752
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License Number State | FL
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