Provider Demographics
NPI:1508468869
Name:LA SAGRADA FAMILIA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LA SAGRADA FAMILIA MEDICAL CENTER INC
Other - Org Name:LA SAGRADA FAMILIA MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ BERGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-615-2843
Mailing Address - Street 1:7270 NW 12TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1941
Mailing Address - Country:US
Mailing Address - Phone:786-615-2843
Mailing Address - Fax:786-980-1607
Practice Address - Street 1:7270 NW 12TH ST STE 430
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1941
Practice Address - Country:US
Practice Address - Phone:786-615-2843
Practice Address - Fax:786-980-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health