Provider Demographics
NPI:1558803056
Name:CELEN MEDICAL GROUP, CORP
Entity Type:Organization
Organization Name:CELEN MEDICAL GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOSLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-587-2418
Mailing Address - Street 1:7930 NW 36TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6677
Mailing Address - Country:US
Mailing Address - Phone:305-677-9110
Mailing Address - Fax:877-347-5666
Practice Address - Street 1:7930 NW 36TH ST STE 215
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6677
Practice Address - Country:US
Practice Address - Phone:305-677-9110
Practice Address - Fax:305-677-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020648800Medicaid
FL104412200Medicaid
FLHCC12379OtherAHCA