Provider Demographics
NPI:1821579384
Name:FAMILY MEDICAL CLINIC KENDALL LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC KENDALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIZSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-7824
Mailing Address - Street 1:9000 SW 137TH AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1435
Mailing Address - Country:US
Mailing Address - Phone:305-603-7824
Mailing Address - Fax:305-456-2435
Practice Address - Street 1:239 N KROME AVE STE A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6018
Practice Address - Country:US
Practice Address - Phone:305-603-7824
Practice Address - Fax:305-456-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124991261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty