1124408406 NPI number — DLD MEDICAL CENTER INC

Table of content: (NPI 1124408406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124408406 NPI number — DLD MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DLD MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124408406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7250 W 24TH AVE
Provider Second Line Business Mailing Address:
STE 18
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-6575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-797-8789
Provider Business Mailing Address Fax Number:
305-397-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7250 W 24TH AVE
Provider Second Line Business Practice Location Address:
STE 18
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-6575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-797-8789
Provider Business Practice Location Address Fax Number:
305-397-2320
Provider Enumeration Date:
06/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
LAZARO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-797-8789

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)