Organization
ILLUMINA MEDICAL GROUP SPECIALTY, LLC
Active
Organization
ILLUMINA MEDICAL GROUP SPECIALTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGEL ANDRES MONGEOTTI (EXECUTIVE DIRECTOR OF FINANCE)
(305) 254-8900
Entity
Organization
Contact information
Practice address
1914 NW 84TH AVE, DORAL, FL 33126
(305) 254-8900
(305) 254-8902
Mailing address
1914 NW 84TH AVE, DORAL, FL 33126-1030
(305) 254-8900
(305) 254-8902
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L17000260851
STATE DOCUMENT NUMBER
FL
Enumeration date
01/17/2018
Last updated
07/27/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up