Basic Information
| Provider Information | |||||||||
| NPI: | 1104084730 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMOHO HEALTHCARE EXPRESS HIALEAH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDIGO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 SW 74TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056654614 | ||||||||
| FaxNumber: | 3056670239 | ||||||||
| Practice Location | |||||||||
| Address1: | 3141 W 76TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330183885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056654614 | ||||||||
| FaxNumber: | 3056670239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROCHIN | ||||||||
| AuthorizedOfficialFirstName: | GUILLERMO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056654614 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.