Provider Demographics
NPI:1164851515
Name:CUTLER BAY MEDICAL & DIAGNOSTIC CENTER CORP
Entity Type:Organization
Organization Name:CUTLER BAY MEDICAL & DIAGNOSTIC CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-812-6875
Mailing Address - Street 1:20525 SW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2632
Mailing Address - Country:US
Mailing Address - Phone:305-812-6875
Mailing Address - Fax:786-732-0637
Practice Address - Street 1:20525 SW 82ND CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2632
Practice Address - Country:US
Practice Address - Phone:305-812-6875
Practice Address - Fax:786-732-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service