Provider Demographics
NPI:1912677816
Name:BIENESTAR MEDICAL CENTERS OF MIAMI LLC
Entity Type:Organization
Organization Name:BIENESTAR MEDICAL CENTERS OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-295-0479
Mailing Address - Street 1:14201 SW 120TH ST UNIT 103-106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7661
Mailing Address - Country:US
Mailing Address - Phone:305-517-3000
Mailing Address - Fax:305-517-1293
Practice Address - Street 1:14201 SW 120TH ST UNIT 103-106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7661
Practice Address - Country:US
Practice Address - Phone:305-517-3000
Practice Address - Fax:305-517-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center