Provider Demographics
NPI:1154060432
Name:PENATE MEDICAL CENTER 3 LLC
Entity Type:Organization
Organization Name:PENATE MEDICAL CENTER 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-272-9170
Mailing Address - Street 1:8200 SW 117TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4825
Mailing Address - Country:US
Mailing Address - Phone:786-272-9170
Mailing Address - Fax:
Practice Address - Street 1:18900 SW 106TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7697
Practice Address - Country:US
Practice Address - Phone:786-272-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center