Provider Demographics
NPI:1952904195
Name:MEDISANA HEALTH CENTER CORP
Entity type:Organization
Organization Name:MEDISANA HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLEIDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-799-3112
Mailing Address - Street 1:5391 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5924
Mailing Address - Country:US
Mailing Address - Phone:786-636-1310
Mailing Address - Fax:786-636-1311
Practice Address - Street 1:5391 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5924
Practice Address - Country:US
Practice Address - Phone:786-636-1310
Practice Address - Fax:786-636-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109165700Medicaid