| Fardales Medical Center Inc | |
|
8051 W 24th Ave Ste 9 Hialeah FL 33016-5596 | |
| (305) 400-9702 | |
| (305) 397-2165 |
| Full Name | Fardales Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8051 W 24th Ave Ste 9, Hialeah, Florida |
| Authorized Official Name and Position | Maricela Dianexi Fardales (OWNER) |
| Authorized Official Contact | 3054009702 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fardales Medical Center Inc 8051 W 24th Ave Ste 9 Hialeah FL 33016-5596 Ph: (305) 400-9702 | Fardales Medical Center Inc 8051 W 24th Ave Ste 9 Hialeah FL 33016-5596 Ph: (305) 400-9702 |
| NPI Number | 1174990915 |
|---|---|
| Provider Enumeration Date | 08/27/2015 |
| Last Update Date | 05/14/2021 |
| Medicare PECOS PAC ID | 8628336021 |
|---|---|
| Medicare Enrollment ID | O20171212002015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174990915 | NPI | - | NPPES |
| 004570500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | PA9103093 (Florida) | Primary |
| Provider Name | Altagracia Victoria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649220898 PECOS PAC ID: 7416922166 Enrollment ID: I20040827000075 |
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