Provider Demographics
NPI:1508146101
Name:MIRAMAR PRIMARY CARE CENTER LLC
Entity Type:Organization
Organization Name:MIRAMAR PRIMARY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-628-4600
Mailing Address - Street 1:18300 NW 62ND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8200
Mailing Address - Country:US
Mailing Address - Phone:305-628-4600
Mailing Address - Fax:305-628-8090
Practice Address - Street 1:3220 S DOUGLAS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2734
Practice Address - Country:US
Practice Address - Phone:954-433-9923
Practice Address - Fax:954-450-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51638261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care