MEDICARE: BRILLIANT MEDICAL 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1487909552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1840 W 49TH ST STE 700
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST STE 700
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2973
Country	:	US
Telephone Number	:	305-262-6904
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEXIS RIVERON
Credential	:
Telephone Number	:	305-262-6904

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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