Provider Demographics
NPI:1154991453
Name:FAMILY &PEDIATRIC MEDICAL CENTER INC
Entity type:Organization
Organization Name:FAMILY &PEDIATRIC MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-591-2988
Mailing Address - Street 1:3155 NW 82ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1056
Mailing Address - Country:US
Mailing Address - Phone:305-348-1586
Mailing Address - Fax:305-591-2995
Practice Address - Street 1:14850 SW 26TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5930
Practice Address - Country:US
Practice Address - Phone:305-348-1586
Practice Address - Fax:305-591-2995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & PEDIATRIC MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty