MEDICARE: LA ESPERANZA ADULT CARE 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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295380483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA ESPERANZA ADULT CARE CENTER INC

Provider Business Mailing Address
First Line	:	7911 NW 72ND AVE STE 108
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33166-2221
Country	:	US
Telephone Number	:	786-547-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 NW 72ND AVE STE 108
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33166-2221
Country	:	US
Telephone Number	:	786-547-5134
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DEIVYS E ALVAREZ
Credential	:
Telephone Number	:	786-547-5134

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	11/08/2023

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