Provider Demographics
NPI:1275580045
Name:PROFESSIONAL MEDICAL BUILDING GROUP INC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL BUILDING GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRALVYS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-769-1830
Mailing Address - Street 1:590 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1962
Mailing Address - Country:US
Mailing Address - Phone:305-769-1830
Mailing Address - Fax:305-769-2715
Practice Address - Street 1:590 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1962
Practice Address - Country:US
Practice Address - Phone:305-769-1830
Practice Address - Fax:305-769-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center