Organization
MED-SOURCE GROUP LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OTTO J VALDES (CEO)
(786) 443-0873
Entity
Organization
Contact information
Practice address
15476 NW 77TH CT, MIAMI LAKES, FL 33016-5823
(786) 443-0873
Mailing address
15476 NW 77TH CT, MIAMI LAKES, FL 33016-5823
(786) 443-0873
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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