MEDICARE: D.J. MEDIACAL 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1730132796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.J. MEDIACAL CENTER

Provider Business Mailing Address
First Line	:	1140 W 50TH ST
Second Line	:	SUITE 400 B
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-556-3536
Fax Number	:	305-556-3592

Provider Business Practice Location Address
First Line	:	1140 W 50TH ST
Second Line	:	SUITE 400 B
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-556-3536
Fax Number	:	305-556-3592

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSVALDO DIAZ
Credential	:
Telephone Number	:	305-556-3536

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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Directions to “D.J. MEDIACAL CENTER ” Practice Location

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