Provider Demographics
NPI:1407439532
Name:CENTURY MEDICAL CENTER OF SOUTH DADE ,L.L.C
Entity Type:Organization
Organization Name:CENTURY MEDICAL CENTER OF SOUTH DADE ,L.L.C
Other - Org Name:LITTLE HAVANA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:MIREYA
Authorized Official - Last Name:GALLARDO PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-461-1020
Mailing Address - Street 1:1645 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7344
Mailing Address - Country:US
Mailing Address - Phone:305-642-1042
Mailing Address - Fax:
Practice Address - Street 1:1119 SW 1ST STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:305-642-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty