MEDICARE: NOSTRUM MEDICAL CENTER WESTCHESTER 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1447527197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOSTRUM MEDICAL CENTER WESTCHESTER LLC

Provider Business Mailing Address
First Line	:	9100 SW 24TH ST STE 1
Second Line	:	2ND FL
City	:	MIAMI
State	:	FL
Zip	:	33165-2066
Country	:	US
Telephone Number	:	305-226-4811
Fax Number	:	305-226-1202

Provider Business Practice Location Address
First Line	:	9100 SW 24TH ST STE 1
Second Line	:	2ND FL
City	:	MIAMI
State	:	FL
Zip	:	33165-2066
Country	:	US
Telephone Number	:	305-226-4811
Fax Number	:	305-226-1202

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANTOS T DE LA PAZ
Credential	:	M.D.
Telephone Number	:	305-226-4811

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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