| Corazon De Jesus Medical Center Llc | |
|
4908 Sw 8th St Coral Gables FL 33134-2439 | |
| (305) 964-7749 | |
| (786) 534-2917 |
| Full Name | Corazon De Jesus Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4908 Sw 8th St, Coral Gables, Florida |
| Authorized Official Name and Position | Carlos Alberto Diaz Valladares (OWNER) |
| Authorized Official Contact | 7864884301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corazon De Jesus Medical Center Llc 4908 Sw 8th St Coral Gables FL 33134-2439 Ph: (305) 964-7749 | Corazon De Jesus Medical Center Llc 4908 Sw 8th St Coral Gables FL 33134-2439 Ph: (305) 964-7749 |
| NPI Number | 1174390454 |
|---|---|
| Provider Enumeration Date | 12/07/2023 |
| Last Update Date | 03/12/2024 |
| Medicare PECOS PAC ID | 7012369358 |
|---|---|
| Medicare Enrollment ID | O20240123000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174390454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Julian Diavanti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871800664 PECOS PAC ID: 3678711470 Enrollment ID: I20170816004027 |
| Provider Name | Carlos Diaz Valladares |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215506878 PECOS PAC ID: 4082793500 Enrollment ID: I20211020002052 |
| Provider Name | Aida Viera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811562234 PECOS PAC ID: 3476941600 Enrollment ID: I20211103000592 |
| Provider Name | Olga Johanna Morgan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003509936 PECOS PAC ID: 6608238795 Enrollment ID: I20230822002217 |
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