Organization
NIDI MEDICAL GROUP CORP
Active
Organization
NIDI MEDICAL GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NIDIALYS VAZQUEZ (ADMINISTRATION / MANAGER)
(305) 817-3735
Entity
Organization
Contact information
Practice address
6031 SW 8TH ST, WEST MIAMI, FL 33144-5039
(305) 262-5552
(305) 262-5575
Mailing address
6838 W 25TH AVE, HIALEAH, FL 33016-5467
(305) 817-3735
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC7030
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7030
LICENSE NUMBER FOR AHCA
FL
Enumeration date
05/12/2006
Last updated
08/22/2020
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