Provider Demographics
NPI:1558436667
Name:LITTLE HAVANA ACTIVITIES & NUTRITION CENTERS OF DADE COUNTY, INC.
Entity Type:Organization
Organization Name:LITTLE HAVANA ACTIVITIES & NUTRITION CENTERS OF DADE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-858-0887
Mailing Address - Street 1:700 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3311
Mailing Address - Country:US
Mailing Address - Phone:305-860-3988
Mailing Address - Fax:305-854-2226
Practice Address - Street 1:700 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3311
Practice Address - Country:US
Practice Address - Phone:305-860-3988
Practice Address - Fax:305-854-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39019Medicare ID - Type UnspecifiedPRO SALUD