Provider Demographics
NPI:1760413223
Name:RDM MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:RDM MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-823-1959
Mailing Address - Street 1:1840 W 49TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2978
Mailing Address - Country:US
Mailing Address - Phone:305-823-1959
Mailing Address - Fax:305-823-1977
Practice Address - Street 1:1840 W 49TH ST STE 404
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2978
Practice Address - Country:US
Practice Address - Phone:305-823-1959
Practice Address - Fax:305-823-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6354261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC6354OtherSTATE HEALTH CARE LICENSE
FLK9245Medicare ID - Type Unspecified