Provider Demographics
NPI:1336473917
Name:IDEAL MEDICAL CENTER OF MIAMI
Entity Type:Organization
Organization Name:IDEAL MEDICAL CENTER OF MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-635-7710
Mailing Address - Street 1:1490 N.W. 27 AVENUE
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-635-7710
Mailing Address - Fax:305-637-8122
Practice Address - Street 1:1490 NW 27TH AVE
Practice Address - Street 2:SUITE # 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2157
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:305-637-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty