Provider Demographics
NPI:1376120477
Name:AGAPE HEALTH MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:AGAPE HEALTH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-290-7428
Mailing Address - Street 1:90130 OLD HWY
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2368
Mailing Address - Country:US
Mailing Address - Phone:305-852-9300
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 600
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4728
Practice Address - Country:US
Practice Address - Phone:305-852-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty