Provider Demographics
NPI:1164005948
Name:AMERICAN GROUP MEDICAL CENTER INC
Entity Type:Organization
Organization Name:AMERICAN GROUP MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-355-1964
Mailing Address - Street 1:8181 NW 36TH ST STE 17C
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6661
Mailing Address - Country:US
Mailing Address - Phone:786-355-1964
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST STE 17C
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6661
Practice Address - Country:US
Practice Address - Phone:786-355-1964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health