Provider Demographics
NPI:1447806286
Name:CENTRUM MEDICAL CENTER-MIAMI GARDENS, LLC
Entity Type:Organization
Organization Name:CENTRUM MEDICAL CENTER-MIAMI GARDENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VICTORERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-2929
Mailing Address - Street 1:9250 NW 36TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2775
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:305-579-6673
Practice Address - Street 1:4767 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2933
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty