| Legacy Medical Center Llc | |
|
6741 Sw 24th St Ste 46 Miami FL 33155-1767 | |
| (786) 427-7059 | |
| Not Available |
| Full Name | Legacy Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 6741 Sw 24th St Ste 46, Miami, Florida |
| Authorized Official Name and Position | Alfredo Cuba (CEO) |
| Authorized Official Contact | 7862633100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Center Llc 6741 Sw 24th St Ste 46 Miami FL 33155-1767 Ph: (786) 427-7059 | Legacy Medical Center Llc 6741 Sw 24th St Ste 46 Miami FL 33155-1767 Ph: (786) 427-7059 |
| NPI Number | 1700465226 |
|---|---|
| Provider Enumeration Date | 04/02/2021 |
| Last Update Date | 05/18/2022 |
| Medicare PECOS PAC ID | 7719370345 |
|---|---|
| Medicare Enrollment ID | O20220203001115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700465226 | NPI | - | NPPES |
| 101681100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Carlos Jacinto Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487011557 PECOS PAC ID: 1355632720 Enrollment ID: I20161018000006 |
| Provider Name | Roberto E Gimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508239872 PECOS PAC ID: 9830485291 Enrollment ID: I20170510002168 |
| Provider Name | Olga L Mendoza |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1306912878 PECOS PAC ID: 0941112387 Enrollment ID: I20190710002433 |
| Provider Name | Sabih Iqbal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205330024 PECOS PAC ID: 5395141097 Enrollment ID: I20210903001578 |
| Provider Name | Juan M Guzman Otero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992314058 PECOS PAC ID: 7618365362 Enrollment ID: I20211028002322 |
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