Provider Demographics
NPI:1972997682
Name:HIALEAH MEDICAL, INC.
Entity Type:Organization
Organization Name:HIALEAH MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LA O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-334-6170
Mailing Address - Street 1:4980 W 10TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3437
Mailing Address - Country:US
Mailing Address - Phone:786-972-5114
Mailing Address - Fax:305-456-6194
Practice Address - Street 1:4980 W 10TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3437
Practice Address - Country:US
Practice Address - Phone:786-972-5114
Practice Address - Fax:305-456-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty