Provider Demographics
NPI:1629098017
Name:MIAMI DADE HEALTH CENTERS
Entity Type:Organization
Organization Name:MIAMI DADE HEALTH CENTERS
Other - Org Name:MIAMI DADE HEALTH AND REHABILITATION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-0590
Mailing Address - Street 1:3233 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5427
Mailing Address - Country:US
Mailing Address - Phone:305-642-0590
Mailing Address - Fax:305-643-6326
Practice Address - Street 1:16800 NW 2ND AVE
Practice Address - Street 2:STE. 103
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5549
Practice Address - Country:US
Practice Address - Phone:305-651-8770
Practice Address - Fax:305-651-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1133Medicare ID - Type Unspecified