Provider Demographics
NPI:1407311491
Name:ABUELOS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ABUELOS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-486-9878
Mailing Address - Street 1:3383 NW 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4140
Mailing Address - Country:US
Mailing Address - Phone:786-486-9878
Mailing Address - Fax:305-642-3865
Practice Address - Street 1:3383 NW 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4140
Practice Address - Country:US
Practice Address - Phone:786-486-9878
Practice Address - Fax:305-642-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center