Provider Demographics
NPI:1679832679
Name:KIDNEY SPECIALTY CENTER INC.
Entity Type:Organization
Organization Name:KIDNEY SPECIALTY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-548-4063
Mailing Address - Street 1:219 NW 12TH AVE
Mailing Address - Street 2:SUITE C5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-2205
Mailing Address - Country:US
Mailing Address - Phone:305-548-4000
Mailing Address - Fax:
Practice Address - Street 1:219 NW 12TH AVE
Practice Address - Street 2:SUITE C5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-2205
Practice Address - Country:US
Practice Address - Phone:305-548-4063
Practice Address - Fax:305-545-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty