Provider Demographics
NPI:1629688304
Name:LATINO MEDICAL CENTER IV, INC
Entity Type:Organization
Organization Name:LATINO MEDICAL CENTER IV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-879-9526
Mailing Address - Street 1:12800-12880 NWW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168
Mailing Address - Country:US
Mailing Address - Phone:786-636-6183
Mailing Address - Fax:786-657-2623
Practice Address - Street 1:12800-12880 NWW 7TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:786-636-6183
Practice Address - Fax:786-657-2623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATINO MEDICAL CENTER IV, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010902500Medicaid