Provider Demographics
NPI:1811122484
Name:LIBERTAD MEDICAL CENTER INC.
Entity type:Organization
Organization Name:LIBERTAD MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAVICENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-763-5402
Mailing Address - Street 1:8180 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6645
Mailing Address - Country:US
Mailing Address - Phone:305-716-0046
Mailing Address - Fax:305-716-0049
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:305-716-0046
Practice Address - Fax:305-716-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center