Organization
ILLUMINA MEDICAL GROUP MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL MONGEOTTI (EXECUTIVE DIRECTOR OF FINANCE)
(305) 254-8900
Entity
Organization
Contact information
Practice address
1914 NW 84TH AVE, DORAL, FL 33126-1030
(305) 254-8900
(305) 254-8902
Mailing address
1914 NW 84TH AVE, DORAL, FL 33126-1030
(305) 254-8900
(305) 254-8902
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2017
Last updated
07/21/2022
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