Provider Demographics
NPI:1780860668
Name:MEDCHOICE OF WEST HIALEAH LLC
Entity Type:Organization
Organization Name:MEDCHOICE OF WEST HIALEAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-828-0048
Mailing Address - Street 1:PO BOX 141799
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33144-1799
Mailing Address - Country:US
Mailing Address - Phone:305-828-0048
Mailing Address - Fax:305-828-2639
Practice Address - Street 1:1255 W 46TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3283
Practice Address - Country:US
Practice Address - Phone:305-828-0048
Practice Address - Fax:305-828-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty