Provider Demographics
NPI:1851064653
Name:LA COLONIA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LA COLONIA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YENIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:FMG
Authorized Official - Phone:305-608-1082
Mailing Address - Street 1:167 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2211
Mailing Address - Country:US
Mailing Address - Phone:305-823-3312
Mailing Address - Fax:786-360-2327
Practice Address - Street 1:20453 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1870
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:786-360-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service