Organization
MED LAKE CENTER
Active
Other names
G & I Medical Research LLc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA GISSELLE BOU CEO (CEO MANAGER)
(786) 332-4991
Entity
Organization
Contact information
Practice address
16371 NW 67TH AVE, MIAMI LAKES, FL 33014-6044
(786) 332-4991
(786) 409-2037
Mailing address
16371 NW 67TH AVE, MIAMI LAKES, FL 33014-6044
(786) 332-4991
(786) 409-2037
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
MD 62905
FL
Other
Enumeration date
09/17/2014
Last updated
09/17/2014
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