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General NPI Number Information
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NPI Number | 1811568959
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Entity Type | Organization
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Legal Business Name | IC GROUP-MEDICAL LLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 2721 SW 137TH AVE STE 117
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City | MIAMI
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State | FL
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Zip | 33175-6319
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Country | US
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Telephone | 786-703-9954
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 SW 137TH AVE STE 117
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City | MIAMI
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State | FL
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Zip | 33175-6319
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Country | US
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Telephone | 786-703-9954
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | AILYN RODRIGUEZ MONZON
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Credential | APRN
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Telephone | 786-703-9954
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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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