Provider Demographics
NPI:1609184407
Name:MAGI HEALTH CARE CLINIC INC
Entity Type:Organization
Organization Name:MAGI HEALTH CARE CLINIC INC
Other - Org Name:ABUELITOS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-422-7374
Mailing Address - Street 1:5803 NW 151ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2478
Mailing Address - Country:US
Mailing Address - Phone:786-422-7374
Mailing Address - Fax:786-422-7375
Practice Address - Street 1:5803 NW 151ST ST STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2478
Practice Address - Country:US
Practice Address - Phone:786-422-7374
Practice Address - Fax:786-422-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8678261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609184407Medicaid