| Organization Name: | BLUE LAGOON MEDICAL CENTER INC |
| NPI Number: | 1083097281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICARDO MONTPELLER ACOSTA (PRESIDENT) |
| Mailing Address: | 4355 W 16th Ave Ste 211a Hialeah |
| State: | FL US |
| Postal Code: | 330127670 |
| Phone Number: | 7863049107 |
| Fax Number: | 7863640230 |
| NPI Enumeration Date: | 07/07/2015 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |