| Santurce Medical Center Llc | |
|
500 Vonderburg Dr Ste 305 Brandon FL 33511-5976 | |
| (813) 651-0005 | |
| (813) 902-7234 |
| Full Name | Santurce Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 500 Vonderburg Dr Ste 305, Brandon, Florida |
| Authorized Official Name and Position | Orlando E Mieles (MD/CEO) |
| Authorized Official Contact | 8136510005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santurce Medical Center Llc 500 Vonderburg Dr Suite 305 Brandon FL 33511-5964 Ph: (813) 624-9399 | Santurce Medical Center Llc 500 Vonderburg Dr Ste 305 Brandon FL 33511-5976 Ph: (813) 651-0005 |
| NPI Number | 1649725029 |
|---|---|
| Provider Enumeration Date | 08/16/2016 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6901180801 |
|---|---|
| Medicare Enrollment ID | O20170221000367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649725029 | NPI | - | NPPES |
| 1700149143 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Orlando Enrique Mieles |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1700149143 PECOS PAC ID: 5496973810 Enrollment ID: I20170302001112 |
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