Provider Demographics
NPI:1811038458
Name:PELAYO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PELAYO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-1500
Mailing Address - Street 1:1500 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2043
Mailing Address - Country:US
Mailing Address - Phone:305-448-1500
Mailing Address - Fax:305-448-8681
Practice Address - Street 1:1500 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2043
Practice Address - Country:US
Practice Address - Phone:305-448-1500
Practice Address - Fax:305-448-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380201900Medicaid
FL380201900Medicaid