Provider Demographics
NPI:1700533643
Name:LUQUE MEDICAL CENTER, CORP
Entity Type:Organization
Organization Name:LUQUE MEDICAL CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-362-2818
Mailing Address - Street 1:13205 SW 137TH AVE STE 128
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5334
Mailing Address - Country:US
Mailing Address - Phone:786-362-2818
Mailing Address - Fax:
Practice Address - Street 1:13205 SW 137TH AVE STE 128
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5334
Practice Address - Country:US
Practice Address - Phone:786-362-2818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management