Organization
IFA MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIEZER GONZALEZ (PRESIDENT)
(305) 207-4443
Entity
Organization
Contact information
Practice address
1695 SW 107TH AVE, SUITE 201, MIAMI, FL 33165-7344
(305) 207-4443
(305) 207-4442
Mailing address
1695 SW 107TH AVE, SUITE 201, MIAMI, FL 33165-7344
(305) 207-4443
(305) 207-4442
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236497
FDA CERTIFIED MAMMOGRAPHY
FL
01
—
V3102
BLUE CROSS AND BLUE SHIELD
FL
Enumeration date
06/11/2008
Last updated
07/22/2008
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