Provider Demographics
NPI:1568216422
Name:MAXIMA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MAXIMA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADIARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-879-8040
Mailing Address - Street 1:10540 NW 26TH ST STE G201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5933
Mailing Address - Country:US
Mailing Address - Phone:786-879-8040
Mailing Address - Fax:786-879-8050
Practice Address - Street 1:10540 NW 26TH ST STE G201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5933
Practice Address - Country:US
Practice Address - Phone:786-879-8040
Practice Address - Fax:786-879-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)