Provider Demographics
NPI:1710372313
Name:FAMILY PRACTICE CENTER
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-220-6433
Mailing Address - Street 1:937A SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3206
Mailing Address - Country:US
Mailing Address - Phone:786-220-6433
Mailing Address - Fax:786-332-2811
Practice Address - Street 1:937A SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3206
Practice Address - Country:US
Practice Address - Phone:786-220-6433
Practice Address - Fax:786-332-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty