Provider Demographics
NPI:1285901926
Name:NOSTRUM MEDICAL CENTER WEST DADE LLC
Entity type:Organization
Organization Name:NOSTRUM MEDICAL CENTER WEST DADE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-223-3580
Mailing Address - Street 1:4155 SW 130TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3414
Mailing Address - Country:US
Mailing Address - Phone:305-223-3580
Mailing Address - Fax:305-223-3582
Practice Address - Street 1:4155 SW 130TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3414
Practice Address - Country:US
Practice Address - Phone:305-223-3580
Practice Address - Fax:305-223-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty