Provider Demographics
NPI:1063847374
Name:DOLPHIN MEDICAL CENTER
Entity Type:Organization
Organization Name:DOLPHIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MONTEAGUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-712-9916
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:STE 5B
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:786-712-9916
Mailing Address - Fax:305-603-9850
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:STE 5B
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:786-712-9916
Practice Address - Fax:305-603-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10585261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center