Organization Name: | MED LAKE CENTER LLC |
NPI Number: | 1518340124 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MAYRA LOURDES ZENO (MEDICAL DIRECTOR) |
Mailing Address: | 16371 Nw 67th Ave Miami Lakes |
State: | FL US |
Postal Code: | 330146044 |
Phone Number: | 7863324991 |
Fax Number: | 7864092037 |
NPI Enumeration Date: | 06/30/2015 |
NPI Last Update Date: | 10/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | HCC11818 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |