Organization Name: | BUENA VISTA MEDICAL CENTER INC |
NPI Number: | 1205094034 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY A SPIEGEL (PDT) |
Mailing Address: | 11300 Nw 87th Ct Ste 167 #167 Hialeah Gardens |
State: | FL US |
Postal Code: | 330184521 |
Phone Number: | 3058287520 |
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: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |