MEDICARE: PENATE MEDICAL CENTER 1 LLC

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	:	1295474575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENATE MEDICAL CENTER 1 LLC

Provider Business Mailing Address
First Line	:	8200 SW 117TH AVE STE 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4825
Country	:	US
Telephone Number	:	786-272-9170
Fax Number	:

Provider Business Practice Location Address
First Line	:	14788 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4070
Country	:	US
Telephone Number	:	786-272-9170
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	CLARA PENATE
Credential	:
Telephone Number	:	786-436-0290

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	06/03/2022

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Directions to “PENATE MEDICAL CENTER 1 LLC ” Practice Location

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