| Blue Lagoon Medical Center Inc | |
|
4355 W 16th Ave Ste 211a Hialeah FL 33012-7670 | |
| (786) 304-9107 | |
| (786) 364-0230 |
| Full Name | Blue Lagoon Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4355 W 16th Ave Ste 211a, Hialeah, Florida |
| Authorized Official Name and Position | Ricardo Montpeller Acosta (PRESIDENT) |
| Authorized Official Contact | 7863049107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lagoon Medical Center Inc 4355 W 16th Ave Ste 211a Hialeah FL 33012-7670 Ph: (786) 304-9107 | Blue Lagoon Medical Center Inc 4355 W 16th Ave Ste 211a Hialeah FL 33012-7670 Ph: (786) 304-9107 |
| NPI Number | 1083097281 |
|---|---|
| Provider Enumeration Date | 07/07/2015 |
| Last Update Date | 07/08/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083097281 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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