MEDICARE: DE CESPEDES MEDICAL CENTER 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME62701	FL

General Provider Information

NPI Number	:	1740697325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE CESPEDES MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	9833 E HIBISCUS ST UNIT 571136
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33257-5075
Country	:	US
Telephone Number	:	954-432-8887
Fax Number	:	954-432-8808

Provider Business Practice Location Address
First Line	:	3085 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4424
Country	:	US
Telephone Number	:	954-432-8887
Fax Number	:	954-432-8808

Authorized Official
Title or Position	:	OWNER
Name	:	KARLA CRISTINA DE CESPEDES
Credential	:
Telephone Number	:	954-432-8887

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	05/31/2024

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