Provider Demographics
NPI:1558962019
Name:LDG MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:LDG MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORROTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-492-5983
Mailing Address - Street 1:4485 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7517
Mailing Address - Country:US
Mailing Address - Phone:305-492-5983
Mailing Address - Fax:
Practice Address - Street 1:4485 STIRLING RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7517
Practice Address - Country:US
Practice Address - Phone:305-492-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy