Provider Demographics
NPI:1417612243
Name:KIDNEY SPECIALTY CENTER, INC.
Entity Type:Organization
Organization Name:KIDNEY SPECIALTY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-606-0337
Mailing Address - Street 1:219 NW 12TH AVE STE C-5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-2205
Mailing Address - Country:US
Mailing Address - Phone:305-548-4063
Mailing Address - Fax:305-545-1515
Practice Address - Street 1:4302 ALTON RD STE 760
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2893
Practice Address - Country:US
Practice Address - Phone:305-548-4063
Practice Address - Fax:305-545-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty