Provider Demographics
NPI:1336419050
Name:CENTRO MEDICO BOURNIGAL, S.A
Entity Type:Organization
Organization Name:CENTRO MEDICO BOURNIGAL, S.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-931-1717
Mailing Address - Street 1:BM: 0300095, 8400 NW 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122
Mailing Address - Country:US
Mailing Address - Phone:407-931-1717
Mailing Address - Fax:407-931-2121
Practice Address - Street 1:CALLE ANTERA MOTA S/N APARTADO POSTAL NO.25
Practice Address - Street 2:
Practice Address - City:PUERTO PLATA
Practice Address - State:DOMINCAN REPUBLIC
Practice Address - Zip Code:NONE
Practice Address - Country:DO
Practice Address - Phone:809-586-2342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital