Provider Demographics
NPI:1972987162
Name:MY MD ON WHEEL LLC
Entity Type:Organization
Organization Name:MY MD ON WHEEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:786-542-6896
Mailing Address - Street 1:10300 SUNSET DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:786-542-6896
Mailing Address - Fax:786-580-5178
Practice Address - Street 1:10300 SUNSET DR
Practice Address - Street 2:SUITE 280
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:786-542-6896
Practice Address - Fax:786-580-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center