Basic Information
| Provider Information | |||||||||
| NPI: | 1487627642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGERY CENTER OF CORAL GABLES LLC | ||||||||
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| OtherOrganizationName: | SURGERY CENTER OF CORAL GABLES LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1097 S LE JEUNE RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331342675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054611300 | ||||||||
| FaxNumber: | 3054427364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1097 S LE JEUNE RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331342675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054611300 | ||||||||
| FaxNumber: | 3054427364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARAN | ||||||||
| AuthorizedOfficialFirstName: | ALBERTO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3054422020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 836 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 070948400 | 05 | FL | MEDICAID |