Organization
EBENEZER MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONEL TOMAS SANTOS RODRIGUEZ (OWNER)
(786) 712-8252
Entity
Organization
Contact information
Practice address
2300 W 84TH ST STE 304, HIALEAH, FL 33016-5773
(786) 666-0590
(786) 666-0591
Mailing address
2300 W 84TH ST STE 304, HIALEAH, FL 33016-5773
(786) 666-0590
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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