Provider Demographics
NPI:1164010245
Name:EASTERN MEDICAL KENDALL
Entity Type:Organization
Organization Name:EASTERN MEDICAL KENDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-925-7949
Mailing Address - Street 1:11410 N KENDALL DR STE 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1031
Mailing Address - Country:US
Mailing Address - Phone:305-279-2227
Mailing Address - Fax:305-239-9227
Practice Address - Street 1:11410 N KENDALL DR STE 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1031
Practice Address - Country:US
Practice Address - Phone:305-279-2227
Practice Address - Fax:305-239-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty