Organization
M A MEDICAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO J. HERNANDEZ (PRESIDENT OWNER)
(954) 316-8496
Entity
Organization
Contact information
Practice address
5450 S STATE ROAD 7, BAY 3, DAVIE, FL 33314-6442
(954) 316-8496
(954) 316-8497
Mailing address
5450 S STATE ROAD 7, BAY 3, DAVIE, FL 33314-6442
(954) 316-8496
(954) 316-8497
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC6842
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC6842
AHCA LICENSE
FL
Enumeration date
07/22/2006
Last updated
07/16/2007
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