MEDICARE: UNIVERSAL MEDICAL CENTER OF FLORIDA CITY, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1730402801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MEDICAL CENTER OF FLORIDA CITY, LLC

Provider Business Mailing Address
First Line	:	751 W PALM DR
Second Line	:
City	:	FLORIDA CITY
State	:	FL
Zip	:	33034-3223
Country	:	US
Telephone Number	:	786-377-0120
Fax Number	:	786-237-3771

Provider Business Practice Location Address
First Line	:	751 W PALM DR
Second Line	:
City	:	FLORIDA CITY
State	:	FL
Zip	:	33034-3223
Country	:	US
Telephone Number	:	786-377-0120
Fax Number	:	786-237-3771

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. OCTAVIO BRAVO
Credential	:	R.N.
Telephone Number	:	786-422-6525

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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