Organization
EVELYN MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO M CARRALERO (PRESIDENT)
(305) 820-0095
Entity
Organization
Contact information
Practice address
1840 W 49TH ST, SUITE 227, HIALEAH, FL 33012-2942
(305) 820-0095
(305) 820-0095
Mailing address
1840 W 49TH ST, SUITE 227, HIALEAH, FL 33012-2942
(305) 820-0095
(305) 820-0095
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
HCC5602
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC5602
AHCA HEALTH CARE CLINIC
FL
Enumeration date
03/28/2007
Last updated
08/22/2020
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