Provider Demographics
NPI:1619588324
Name:MIAMI LAKES DOCTOR'S LLC
Entity Type:Organization
Organization Name:MIAMI LAKES DOCTOR'S LLC
Other - Org Name:MIAMI LAKES DOCTOR'S LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YANET
Authorized Official - Middle Name:TEJEDA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:786-797-7140
Mailing Address - Street 1:5757 NW 151ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2482
Mailing Address - Country:US
Mailing Address - Phone:786-353-2058
Mailing Address - Fax:786-353-2087
Practice Address - Street 1:5779 NW 151ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2483
Practice Address - Country:US
Practice Address - Phone:786-353-2058
Practice Address - Fax:786-353-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty