Provider Demographics
NPI:1578919759
Name:DELACALLE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:DELACALLE MEDICAL CENTER LLC
Other - Org Name:DELACALLE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LOBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-486-9761
Mailing Address - Street 1:10775 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7043
Mailing Address - Country:US
Mailing Address - Phone:305-321-5927
Mailing Address - Fax:305-360-4217
Practice Address - Street 1:10775 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7043
Practice Address - Country:US
Practice Address - Phone:305-321-5927
Practice Address - Fax:305-360-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21153261Q00000X
FLME90679261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center