Provider Demographics
NPI:1770045494
Name:LA EDAD PRODIGIOSA INC
Entity Type:Organization
Organization Name:LA EDAD PRODIGIOSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-445-3463
Mailing Address - Street 1:1531 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2031
Mailing Address - Country:US
Mailing Address - Phone:786-445-3463
Mailing Address - Fax:786-701-3994
Practice Address - Street 1:18900 SW 106TH AVE STE 101-102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-7697
Practice Address - Country:US
Practice Address - Phone:786-445-3463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care