Provider Demographics
NPI:1659750867
Name:CENTRO MEDICO INTEGRATIVO
Entity Type:Organization
Organization Name:CENTRO MEDICO INTEGRATIVO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-931-1717
Mailing Address - Street 1:8260 NW 14TH STREET
Mailing Address - Street 2:D-3216
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:407-931-1717
Mailing Address - Fax:407-429-3834
Practice Address - Street 1:ROYAL RECIDENCE, FRENTE BANCO POPULAR
Practice Address - Street 2:
Practice Address - City:CABARETE
Practice Address - State:DOMINICAN REPUBLIC
Practice Address - Zip Code:00000
Practice Address - Country:DO
Practice Address - Phone:809-571-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center