Provider Demographics
NPI:1073978409
Name:QUEVEDO MEDICAL INC
Entity Type:Organization
Organization Name:QUEVEDO MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-270-6743
Mailing Address - Street 1:7250 W 20TH AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:786-270-6743
Mailing Address - Fax:305-234-3322
Practice Address - Street 1:7250 W 20TH AVE
Practice Address - Street 2:STE 2
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:786-270-6743
Practice Address - Fax:305-234-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service