Provider Demographics
NPI:1942851951
Name:PLANET HEALTH MEDICAL CENTER
Entity Type:Organization
Organization Name:PLANET HEALTH MEDICAL CENTER
Other - Org Name:PLANET HEALTH MEDICAL CENTER, CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NALANYS
Authorized Official - Middle Name:CARIDAD
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-586-4456
Mailing Address - Street 1:10305 NW 41ST ST STE 115
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2975
Mailing Address - Country:US
Mailing Address - Phone:305-883-2001
Mailing Address - Fax:
Practice Address - Street 1:10305 NW 41ST ST STE 115
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2975
Practice Address - Country:US
Practice Address - Phone:305-883-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty