MEDICARE: ZEQUEIRA MEDICAL CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1013963008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEQUEIRA MEDICAL CLINIC CORP

Provider Business Mailing Address
First Line	:	1840 W 49TH ST
Second Line	:	SUITE 737
City	:	HIALEAH
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	305-558-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST
Second Line	:	SUITE 737
City	:	HIALEAH
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	305-558-6008
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCOS A ZEQUEIRA
Credential	:
Telephone Number	:	305-558-6008

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/22/2020

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