| NPI | 1013885128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY FERNANDEZ CANIZARES Authorized Official 786-355-9063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |