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Organization
MGM IPA DADE 001 LLC
Active
Organization
MGM IPA DADE 001 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO ARMANDO ESPINO JR. (CEO/PRESIDENT)
(786) 395-1165
Entity
Organization
Contact information
Practice address
8318 SW 193RD ST, CUTLER BAY, FL 33157-8085
(305) 964-5119
Mailing address
8318 SW 193RD ST, CUTLER BAY, FL 33157-8085
(305) 964-5119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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