| Blue Diamond Medical Center Corp. | |
|
16430 Nw 59th Ave Miami Lakes FL 33014-5605 | |
| (305) 456-0148 | |
| Not Available |
| Full Name | Blue Diamond Medical Center Corp. |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 16430 Nw 59th Ave, Miami Lakes, Florida |
| Authorized Official Name and Position | Marcos Jose Carvajal (APRN-FNP) |
| Authorized Official Contact | 3054560148 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Diamond Medical Center Corp. 16430 Nw 59th Ave Ste 202 Miami Lakes FL 33014-5605 Ph: (305) 456-0148 | Blue Diamond Medical Center Corp. 16430 Nw 59th Ave Miami Lakes FL 33014-5605 Ph: (305) 456-0148 |
| NPI Number | 1245967587 |
|---|---|
| Provider Enumeration Date | 08/05/2022 |
| Last Update Date | 04/15/2023 |
| Medicare PECOS PAC ID | 0547636805 |
|---|---|
| Medicare Enrollment ID | O20221012001561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245967587 | NPI | - | NPPES |
| Provider Name | Marcos J Carvajal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649537606 PECOS PAC ID: 7416365325 Enrollment ID: I20210414000705 |
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