Provider Demographics
NPI:1053764829
Name:PALM MEDICAL CENTER - AVENTURA, LLC
Entity type:Organization
Organization Name:PALM MEDICAL CENTER - AVENTURA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISES MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-362-4173
Mailing Address - Street 1:2600 DOUGLAS ROAD
Mailing Address - Street 2:PH7
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-913-9444
Mailing Address - Fax:305-442-1198
Practice Address - Street 1:16241 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4300
Practice Address - Country:US
Practice Address - Phone:305-947-9414
Practice Address - Fax:305-803-2389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH HOLDINGS COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center