Provider Demographics
NPI:1043882061
Name:SAGRADO CORAZON MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SAGRADO CORAZON MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:DIAZ VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-488-4301
Mailing Address - Street 1:700 E 1ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4645
Mailing Address - Country:US
Mailing Address - Phone:305-200-5532
Mailing Address - Fax:786-534-2917
Practice Address - Street 1:700 E 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4645
Practice Address - Country:US
Practice Address - Phone:786-488-4301
Practice Address - Fax:786-534-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty