MEDICARE: LA FAMILIA MEDICAL CENTER II HIALEAH 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1114633237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA FAMILIA MEDICAL CENTER II HIALEAH CORP.

Provider Business Mailing Address
First Line	:	3824 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4127
Country	:	US
Telephone Number	:	786-547-5527
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4127
Country	:	US
Telephone Number	:	786-547-5527
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	LEONARDO OLIVA
Credential	:
Telephone Number	:	305-303-7796

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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