Provider Demographics
NPI:1023422094
Name:NOSTRUM MEDICAL CENTER NORTH WEST
Entity type:Organization
Organization Name:NOSTRUM MEDICAL CENTER NORTH WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-242-5336
Mailing Address - Street 1:2141 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3483
Mailing Address - Country:US
Mailing Address - Phone:305-642-2395
Mailing Address - Fax:305-642-2615
Practice Address - Street 1:2141 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3483
Practice Address - Country:US
Practice Address - Phone:305-642-2395
Practice Address - Fax:305-642-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site