# MED LAKE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** G & I Medical Research
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518340124
- **Authorized official:** MRS. MAYRA LOURDES ZENO MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (786) 332-4991

## Contact information

- **Practice address:** 16371 NW 67TH AVE, MIAMI LAKES, FL 33014-6044
- **Practice address phone:** (786) 332-4991
- **Practice address fax:** (786) 409-2037
- **Mailing address:** 16371 NW 67TH AVE, MIAMI LAKES, FL 33014-6044
- **Mailing address phone:** (786) 332-4991
- **Mailing address fax:** (786) 409-6203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | HCC11818 | FL | Yes |

## Other

- **Enumeration date:** 06/30/2015
- **Last updated:** 10/13/2015