Provider Demographics
NPI:1023496403
Name:CENTRO MEDICO HISPANO CORP
Entity type:Organization
Organization Name:CENTRO MEDICO HISPANO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-647-7383
Mailing Address - Street 1:9300 NW 25TH ST
Mailing Address - Street 2:209
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1508
Mailing Address - Country:US
Mailing Address - Phone:305-647-7383
Mailing Address - Fax:786-534-3568
Practice Address - Street 1:9300 NW 25TH ST
Practice Address - Street 2:209
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1508
Practice Address - Country:US
Practice Address - Phone:305-647-7383
Practice Address - Fax:786-534-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center