Provider Demographics
NPI:1346969516
Name:LOS AMIGOS MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:LOS AMIGOS MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ALONSO GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-454-8395
Mailing Address - Street 1:705 E 8TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4613
Mailing Address - Country:US
Mailing Address - Phone:305-454-8395
Mailing Address - Fax:305-402-0322
Practice Address - Street 1:705 E 8TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-454-8395
Practice Address - Fax:305-402-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care