Organization
STARLITE MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAUL HERNANDEZ (PRESIDENT ADMINISTRATOR)
(305) 468-9373
Entity
Organization
Contact information
Practice address
3785 NW 82ND AVE, SUITE 109, DORAL, FL 33166-6655
(305) 468-9373
(305) 468-9374
Mailing address
3785 NW 82ND AVE, SUITE 109, DORAL, FL 33166-6655
(305) 468-9373
(305) 468-9374
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
HCC9705
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC9705
AGENCY FOR HEALTH CARE ADMINISTRATION EXEMPTION
FL
Enumeration date
08/31/2012
Last updated
08/31/2012
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