Provider Demographics
NPI: | 1386690873 |
---|---|
Name: | ALCAZAR MEDICAL, INC |
Entity type: | Organization |
Organization Name: | ALCAZAR MEDICAL, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SILVINO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NUNEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-265-6667 |
Mailing Address - Street 1: | 7303 W FLAGLER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33144-2505 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-265-6667 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7303 W FLAGLER ST |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33144-2505 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-265-6667 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-26 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | K7487 | Medicare ID - Type Unspecified | MEDICARE |