1104984236 NPI number — HIALEAH MEDICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104984236 NPI number — HIALEAH MEDICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIALEAH MEDICAL ASSOCIATES, 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:
1104984236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8074 NW 103RD ST
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
HIALEAH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33016-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-826-4307
Provider Business Mailing Address Fax Number:
305-826-6790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8074 NW 103RD ST
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
HIALEAH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-826-4307
Provider Business Practice Location Address Fax Number:
305-826-6790
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-826-4307

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374769700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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