Organization Name: | MANASSAS MEDICAL CENTER, INC |
NPI Number: | 1134387715 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PEDRO ANTONIO COLLS (PRESIDENT) |
Mailing Address: | 3900 Nw 79th Ave Suite 326 Doral |
State: | FL US |
Postal Code: | 331666556 |
Phone Number: | 3057176889 |
Fax Number: | |
NPI Enumeration Date: | 05/29/2008 |
NPI Last Update Date: | 05/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | HCC6267 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |