MEDICARE: BELLAGIU SURGICAL CENTER INC

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	261QA1903X	Ambulatory Surgical Clinic/Center	41181	FL

General Provider Information

NPI Number	:	1225564909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAGIU SURGICAL CENTER INC

Provider Business Mailing Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	310-529-9237
Fax Number	:	626-331-3204

Provider Business Practice Location Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	310-529-9237
Fax Number	:	626-331-3204

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CONSTANTINO MENDIETA
Credential	:	M.D.
Telephone Number	:	310-529-9237

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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