Organization
INNOVATION MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELCIDA LOPEZ LMT (PRESIDENT)
(786) 305-4466
Entity
Organization
Contact information
Practice address
1140 W 50TH ST, 302, HIALEAH, FL 33012-3440
(786) 305-4466
Mailing address
1140 W 50TH ST, 302, HIALEAH, FL 33012-3440
(786) 305-4466
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MA32226
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA32226
PROFESSIONAL LICENSE
FL
Enumeration date
04/15/2013
Last updated
04/15/2013
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