Organization
LIFE BLUE MEDICAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA C HERNANDEZ (OWNER)
(305) 456-5380
Entity
Organization
Contact information
Practice address
12260 SW 8TH ST STE 230, MIAMI, FL 33184-1549
(305) 456-5380
(305) 631-2638
Mailing address
12260 SW 8TH ST STE 230, MIAMI, FL 33184-1549
(305) 456-5380
(305) 631-2638
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
HCC11034
FL
Other
Enumeration date
05/22/2017
Last updated
07/21/2022
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