| M&v San Jose Medical Center Llc | |
|
12750 Sw 128th St Ste 108 Miami FL 33186-5380 | |
| (786) 713-0970 | |
| (786) 592-2008 |
| Full Name | M&v San Jose Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 12750 Sw 128th St Ste 108, Miami, Florida |
| Authorized Official Name and Position | Mabel Marichal (MGR) |
| Authorized Official Contact | 7864099490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M&v San Jose Medical Center Llc 12750 Sw 128th St Ste 108 Miami FL 33186-5380 Ph: (786) 409-9490 | M&v San Jose Medical Center Llc 12750 Sw 128th St Ste 108 Miami FL 33186-5380 Ph: (786) 713-0970 |
| NPI Number | 1598318495 |
|---|---|
| Provider Enumeration Date | 07/19/2019 |
| Last Update Date | 05/09/2023 |
| Medicare PECOS PAC ID | 6608291034 |
|---|---|
| Medicare Enrollment ID | O20200803001299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598318495 | NPI | - | NPPES |
| Provider Name | Derek Glenn Bazemore |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639495245 PECOS PAC ID: 5799809067 Enrollment ID: I20100824000799 |
| Provider Name | Robert R Morales Gainza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184212276 PECOS PAC ID: 7315312675 Enrollment ID: I20230420000082 |
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