# BOISE MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629609326
- **Authorized official:** CESAR J DIAZ HERNANDEZ (OWNER)
- **Authorized official phone:** (786) 536-7268

## Contact information

- **Practice address:** 7715 NW 48TH ST STE 350, DORAL, FL 33166-5473
- **Practice address phone:** (786) 536-7268
- **Practice address fax:** (786) 536-7608
- **Mailing address:** 7715 NW 48TH ST STE 350, DORAL, FL 33166-5473
- **Mailing address phone:** (786) 536-7268
- **Mailing address fax:** (786) 536-7608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 01/31/2020
- **Last updated:** 01/31/2020