Basic Information
| Provider Information | |||||||||
| NPI: | 1770974032 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 NE 125TH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056855688 | ||||||||
| FaxNumber: | 7866937731 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 E 25TH ST | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330133825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058350438 | ||||||||
| FaxNumber: | 3056930768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | DE PAZ | ||||||||
| AuthorizedOfficialFirstName: | VENTURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/ CEO | ||||||||
| AuthorizedOfficialTelephone: | 3056855688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.