| Miami Lakes Doctor's Llc | |
|
5779 Nw 151st St Miami Lakes FL 33014-2483 | |
| (786) 353-2058 | |
| (786) 353-2087 |
| Full Name | Miami Lakes Doctor's Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5779 Nw 151st St, Miami Lakes, Florida |
| Authorized Official Name and Position | Yanet Tejeda Garcia (PRESIDENT) |
| Authorized Official Contact | 7867977140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miami Lakes Doctor's Llc 5757 Nw 151st St Miami Lakes FL 33014-2482 Ph: (786) 353-2058 | Miami Lakes Doctor's Llc 5779 Nw 151st St Miami Lakes FL 33014-2483 Ph: (786) 353-2058 |
| NPI Number | 1619588324 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 07/20/2021 |
| Medicare PECOS PAC ID | 9234558420 |
|---|---|
| Medicare Enrollment ID | O20201008000731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619588324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Pedro T Machin |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972644151 PECOS PAC ID: 6709782428 Enrollment ID: I20040624000417 |
| Provider Name | Damaris Valdes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700282399 PECOS PAC ID: 1052603313 Enrollment ID: I20160706001894 |
| Provider Name | Thomas Richard Lange |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952731762 PECOS PAC ID: 8426325127 Enrollment ID: I20170601000537 |
| Provider Name | Guillermo A Fonseca |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1972700714 PECOS PAC ID: 8325308943 Enrollment ID: I20180130002505 |
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