Provider Demographics
NPI:1245361518
Name:PALM LAKE MEDICAL CENTER INC
Entity type:Organization
Organization Name:PALM LAKE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-576-4291
Mailing Address - Street 1:4715 NW 157TH ST
Mailing Address - Street 2:SUITE 111-115
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6435
Mailing Address - Country:US
Mailing Address - Phone:305-405-2939
Mailing Address - Fax:
Practice Address - Street 1:4715 NW 157TH ST
Practice Address - Street 2:SUITE 111-115
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6435
Practice Address - Country:US
Practice Address - Phone:305-405-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty