Provider Demographics
NPI:1225564909
Name:BELLAGIU SURGICAL CENTER INC
Entity Type:Organization
Organization Name:BELLAGIU SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-529-9237
Mailing Address - Street 1:2310 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2314
Mailing Address - Country:US
Mailing Address - Phone:310-529-9237
Mailing Address - Fax:626-331-3204
Practice Address - Street 1:2310 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2314
Practice Address - Country:US
Practice Address - Phone:310-529-9237
Practice Address - Fax:626-331-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41181261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical