Basic Information
| Provider Information | |||||||||
| NPI: | 1285654665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIAMI DADE HEALTH CENTERS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIAMI DADE HEALTH AND REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3233 PALM AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056420590 | ||||||||
| FaxNumber: | 3056436326 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 W FLAGLER ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331351425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056310660 | ||||||||
| FaxNumber: | 3056311362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056420590 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.