Provider Demographics
NPI:1699015701
Name:PALM PLAZA MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PALM PLAZA MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-913-9444
Mailing Address - Street 1:2600 DOUGLAS RD
Mailing Address - Street 2:PH 7
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-913-9444
Mailing Address - Fax:305-913-9445
Practice Address - Street 1:16795 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4201
Practice Address - Country:US
Practice Address - Phone:305-913-7300
Practice Address - Fax:305-362-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEMPLOYER IDENTIFICATION NUMBER