Provider Demographics
NPI:1073925236
Name:V AND R MEDICAL GROUP
Entity Type:Organization
Organization Name:V AND R MEDICAL GROUP
Other - Org Name:LA QUINTA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-883-1060
Mailing Address - Street 1:700 E 1ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-975-7748
Mailing Address - Fax:
Practice Address - Street 1:700 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4406
Practice Address - Country:US
Practice Address - Phone:305-883-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26136332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site