Provider Demographics
NPI:1578823472
Name:MEGA HEALTH CENTER EAST LITTLE HAVANA, INC
Entity Type:Organization
Organization Name:MEGA HEALTH CENTER EAST LITTLE HAVANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-212-1263
Mailing Address - Street 1:721 NW 21ST CT # 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3434
Mailing Address - Country:US
Mailing Address - Phone:786-212-1263
Mailing Address - Fax:786-212-1266
Practice Address - Street 1:721 NW 21ST CT # 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3434
Practice Address - Country:US
Practice Address - Phone:786-212-1263
Practice Address - Fax:786-212-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty