FARDALES MEDICAL CENTER INC NPI 1174990915

NPI Information

NPI: 1174990915
Provider Name: FARDALES MEDICAL CENTER INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 10D2131006

Address:
8051 W 24TH AVE STE 9
HIALEAH, FL
ZIP 33016
Phone: (305) 400-9702
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FARDALES MEDICAL CENTER INC is a primary care clinic center in Hialeah, FL. FARDALES MEDICAL CENTER INC NPI is 1174990915. The provider is registered as an organization entity type.

The provider's business location address is:

8051 W 24TH AVE STE 9
HIALEAH, FL
ZIP 33016-596
Phone: (305) 400-9702
Fax: (305) 397-2165

The provider's authorized official is Maricela Dianexi Fardales .
The authorized official title is Owner and has the following contact phone number (305) 400-9702.

The CLIA number assigned to this NPI record is 10D2131006 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/27/2015 and was last updated on 5/14/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	PA9103093	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004570500	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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