Provider Demographics
NPI:1003865296
Name:PAC MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PAC MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JULIO
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-7740
Mailing Address - Street 1:4311 PALM AVE
Mailing Address - Street 2:SUIT 3
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4021
Mailing Address - Country:US
Mailing Address - Phone:305-823-7740
Mailing Address - Fax:305-823-8527
Practice Address - Street 1:4311 PALM AVE
Practice Address - Street 2:SUIT 3
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4021
Practice Address - Country:US
Practice Address - Phone:305-823-7740
Practice Address - Fax:305-823-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center