Provider Demographics
NPI:1568864650
Name:UNIVERSAL MEDICAL AND RESEARCH CENTER, LLC
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL AND RESEARCH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-3772
Mailing Address - Street 1:801 MONTEREY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2537
Mailing Address - Country:US
Mailing Address - Phone:786-534-3772
Mailing Address - Fax:786-534-3773
Practice Address - Street 1:3780 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1602
Practice Address - Country:US
Practice Address - Phone:786-534-3772
Practice Address - Fax:786-534-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98559261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98559OtherMEDICAL LICENSE