Provider Demographics
NPI:1881202620
Name:USA MEDICAL MANAGEMENT GARDEN, LLC
Entity Type:Organization
Organization Name:USA MEDICAL MANAGEMENT GARDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-608-2948
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 132
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4744
Mailing Address - Country:US
Mailing Address - Phone:305-956-7755
Mailing Address - Fax:786-446-7271
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 132
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4744
Practice Address - Country:US
Practice Address - Phone:305-956-7755
Practice Address - Fax:786-446-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL19000276773OtherLIMITED LIABILITY DOCUMENT