Provider Demographics
NPI:1699011122
Name:INDAGO RESEARCH AND HEALTH CENTER, INC
Entity Type:Organization
Organization Name:INDAGO RESEARCH AND HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-3335
Mailing Address - Street 1:3700 W 12TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4170
Mailing Address - Country:US
Mailing Address - Phone:305-827-3335
Mailing Address - Fax:
Practice Address - Street 1:3700 W 12TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4170
Practice Address - Country:US
Practice Address - Phone:305-827-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0430020000130261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch