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General NPI Number Information
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NPI Number | 1922149178
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Entity Type | Organization
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Legal Business Name | VERSAILLES MEDICAL CENTER, INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 5438 SW 8TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-2267
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Country | US
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Telephone | 305-444-8676
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Fax | 305-444-5181
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Provider Business Mailing Address
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Address Line | 5438 SW 8TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-2267
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Country | US
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Telephone | 305-444-8676
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Fax | 305-444-5181
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. MARINA I DELAMO
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Credential |
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Telephone | 305-444-8676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 090479-8
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License Number State | FL
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