Organization
BLUE LAGOON MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO MONTPELLER ACOSTA MA (PRESIDENT)
(786) 304-9107
Entity
Organization
Contact information
Practice address
4355 W 16TH AVE STE 211A, HIALEAH, FL 33012-7670
(786) 304-9107
(786) 364-0230
Mailing address
4355 W 16TH AVE STE 211A, HIALEAH, FL 33012-7670
(786) 304-9107
(786) 364-0230
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
07/07/2015
Last updated
07/08/2015
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