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NPI Code Detail

MEDICARE: WEST REGIONAL CENTER

MEDICARE: WEST REGIONAL CENTER
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
1174400000XSpecialistHCC3736FL

General Provider Information

NPI Number : 1548290851
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST REGIONAL CENTER
Provider Business Mailing Address
First Line : 1779 W 37TH ST
Second Line : BAY 1
City : HIALEAH
State : FL
Zip : 33012-4671
Country : US
Telephone Number : 305-362-8384
Fax Number : 305-362-8929
Provider Business Practice Location Address
First Line : 1779 W 37TH ST
Second Line : BAY 1
City : HIALEAH
State : FL
Zip : 33012-4671
Country : US
Telephone Number : 305-362-8384
Fax Number : 305-362-8929
Authorized Official
Title or Position : OWNER
Name : LISSETTE BORGES
Credential :
Telephone Number : 786-251-9309
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/22/2020

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Directions to “WEST REGIONAL CENTER ” Practice Location

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