Provider Demographics
NPI:1033415260
Name:DYNASTY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:DYNASTY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:EXPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-270-8030
Mailing Address - Street 1:7000 SW 97TH AVE
Mailing Address - Street 2:106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1494
Mailing Address - Country:US
Mailing Address - Phone:305-270-8030
Mailing Address - Fax:305-270-8040
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-270-8030
Practice Address - Fax:305-270-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center