Provider Demographics
NPI:1487834487
Name:ANGELICAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ANGELICAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EFREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-805-6975
Mailing Address - Street 1:380 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4260
Mailing Address - Country:US
Mailing Address - Phone:305-805-6975
Mailing Address - Fax:305-805-6977
Practice Address - Street 1:380 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4260
Practice Address - Country:US
Practice Address - Phone:305-805-6975
Practice Address - Fax:305-805-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5959208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty