Organization
EVELYN DIAGNOSTIC & MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO M CARRALERO PA (PRESIDENT)
(305) 512-1850
Entity
Organization
Contact information
Practice address
7000 W 12TH AVE, SUITE 15, HIALEAH, FL 33014-5154
(305) 512-1850
(305) 512-1851
Mailing address
7000 W 12TH AVE, SUITE 15, HIALEAH, FL 33014-5154
(305) 512-1850
(305) 512-1851
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC5649
HEALTH CARE CLINIC
FL
Enumeration date
05/31/2007
Last updated
06/27/2008
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