Provider Demographics
NPI:1427353606
Name:LAS BRISAS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:LAS BRISAS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-436-0419
Mailing Address - Street 1:1131 NW 22ND AVE
Mailing Address - Street 2:31
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1131 NW 22ND AVE
Practice Address - Street 2:31
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2738
Practice Address - Country:US
Practice Address - Phone:786-436-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy