Provider Demographics
NPI:1558680132
Name:ALCA HEALTH DIAGNOSTIC CENTER CORP
Entity Type:Organization
Organization Name:ALCA HEALTH DIAGNOSTIC CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-464-0302
Mailing Address - Street 1:2001 NW 7TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3479
Mailing Address - Country:US
Mailing Address - Phone:786-464-0302
Mailing Address - Fax:786-464-0607
Practice Address - Street 1:2001 NW 7TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3479
Practice Address - Country:US
Practice Address - Phone:786-464-0302
Practice Address - Fax:786-464-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8818OtherSTATE LICENSE AHCA