Provider Demographics
NPI:1649764028
Name:POLICLINICA LATINOAMERICANA CORP
Entity Type:Organization
Organization Name:POLICLINICA LATINOAMERICANA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-400-8774
Mailing Address - Street 1:1271 NW 6TH ST # 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4719
Mailing Address - Country:US
Mailing Address - Phone:305-400-8774
Mailing Address - Fax:786-313-3425
Practice Address - Street 1:1271 NW 6TH ST # 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4719
Practice Address - Country:US
Practice Address - Phone:305-400-8774
Practice Address - Fax:786-313-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty