| Century Medical Center Of South Dade ,l.l.c | |
|
1645 Sw 107th Ave Miami FL 33165-7344 | |
| (954) 331-4966 | |
| (954) 212-8486 |
| Full Name | Century Medical Center Of South Dade ,l.l.c |
|---|---|
| Speciality | Family Medicine |
| Location | 1645 Sw 107th Ave, Miami, Florida |
| Authorized Official Name and Position | Caridad Mireya Gallardo Pimentel (PRESIDENT) |
| Authorized Official Contact | 9543314966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Century Medical Center Of South Dade ,l.l.c 1645 Sw 107th Ave Miami FL 33165-7344 Ph: (954) 331-4966 | Century Medical Center Of South Dade ,l.l.c 1645 Sw 107th Ave Miami FL 33165-7344 Ph: (954) 331-4966 |
| NPI Number | 1598371247 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 08/08/2022 |
| Medicare PECOS PAC ID | 9436567583 |
|---|---|
| Medicare Enrollment ID | O20210409001534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598371247 | NPI | - | NPPES |
| Provider Name | Enrique Salvador De La Torre |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306054515 PECOS PAC ID: 7719079441 Enrollment ID: I20070824000683 |
| Provider Name | Nelson Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578759197 PECOS PAC ID: 1153498639 Enrollment ID: I20080925000174 |
| Provider Name | Yaolen Bolanos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942402045 PECOS PAC ID: 1850434788 Enrollment ID: I20100201000487 |
| Provider Name | Caridad Mireya Gallardo Pimentel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477139244 PECOS PAC ID: 8628486776 Enrollment ID: I20210409001476 |
| Provider Name | Yeney Lopez Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841884806 PECOS PAC ID: 7517367592 Enrollment ID: I20210614000151 |
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