Provider Demographics
NPI:1326260928
Name:HEALTH DEPOT INC
Entity Type:Organization
Organization Name:HEALTH DEPOT INC
Other - Org Name:HDI-HEALTH PROMOTION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURUIBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:305-756-4490
Mailing Address - Street 1:P. O. BOX 399124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33239-9124
Mailing Address - Country:US
Mailing Address - Phone:305-756-4490
Mailing Address - Fax:305-756-4493
Practice Address - Street 1:7919 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138
Practice Address - Country:US
Practice Address - Phone:305-756-4490
Practice Address - Fax:305-756-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP98000009728261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
44835Medicare ID - Type Unspecified