Provider Demographics
NPI:1215981618
Name:DOCTOR'S MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:DOCTOR'S MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:VENTURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-685-5688
Mailing Address - Street 1:5605 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4000
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-618-5307
Practice Address - Street 1:1272 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3232
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-687-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063667306Medicaid
FL063667305Medicaid
FL063667310Medicaid
FL063667315Medicaid
FL013915000Medicaid
FL063667307Medicaid
FL063667313Medicaid
FL063667309Medicaid
FL063667314Medicaid
FL063667304Medicaid
FL063667311Medicaid
FL063667312Medicaid
FL063667316Medicaid
FL063667300Medicaid
FL063667308Medicaid