Provider Demographics
NPI:1548741309
Name:MEDICTA HEALTH CORP
Entity Type:Organization
Organization Name:MEDICTA HEALTH CORP
Other - Org Name:MEDICTA HEALTH CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COBO
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:772-777-0374
Mailing Address - Street 1:7299 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2503
Mailing Address - Country:US
Mailing Address - Phone:786-953-4698
Mailing Address - Fax:786-953-4369
Practice Address - Street 1:7299 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2503
Practice Address - Country:US
Practice Address - Phone:786-953-4698
Practice Address - Fax:786-953-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherMASSAGE ESTABLISHMENT