Provider Demographics
NPI:1841805280
Name:CLINICA SUR MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:CLINICA SUR MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-639-8139
Mailing Address - Street 1:18400 NW 75TH PL STE 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2956
Mailing Address - Country:US
Mailing Address - Phone:786-639-8139
Mailing Address - Fax:786-637-2107
Practice Address - Street 1:18400 NW 75TH PL STE 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2956
Practice Address - Country:US
Practice Address - Phone:786-639-8139
Practice Address - Fax:786-637-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health