Provider Demographics
NPI:1295285252
Name:DELTA HEALTHCARE CENTER CORP
Entity type:Organization
Organization Name:DELTA HEALTHCARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:JUNCOSA CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-615-9388
Mailing Address - Street 1:8890 SW 24TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2060
Mailing Address - Country:US
Mailing Address - Phone:786-615-9388
Mailing Address - Fax:844-319-2949
Practice Address - Street 1:8890 SW 24TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2060
Practice Address - Country:US
Practice Address - Phone:786-615-9388
Practice Address - Fax:844-319-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10775261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC10775OtherAHCA