Provider Demographics
NPI: | 1811000193 |
---|---|
Name: | MIAMI DADE HEALTH CENTERS |
Entity Type: | Organization |
Organization Name: | MIAMI DADE HEALTH CENTERS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LUIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRUZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 305-642-0590 |
Mailing Address - Street 1: | 3233 PALM AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | HIALEAH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33012-5427 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-642-0590 |
Mailing Address - Fax: | 305-643-6326 |
Practice Address - Street 1: | 2526 W FLAGLER ST |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33135-1423 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-644-0067 |
Practice Address - Fax: | 305-631-9834 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-17 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302F00000X | Managed Care Organizations | Exclusive Provider Organization |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | K1133 | Medicare ID - Type Unspecified |