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General NPI Number Information
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NPI Number | 1922411347
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Entity Type | Organization
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Legal Business Name | 1ST CLASS MEDICAL CENTERS OF 4 AVE INC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 1015-1025 E 4 AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4103
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Country | US
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Telephone | 786-542-9051
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Fax | 786-542-9052
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Provider Business Mailing Address
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Address Line | 1015-1025 E 4 AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4103
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Country | US
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Telephone | 786-542-9051
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Fax | 786-542-9052
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUDY N DOMINGUEZ
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Credential |
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Telephone | 786-542-9051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC10171
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License Number State | FL
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