Organization
MED ADVANCED CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENIEL PENA (PRESIDENT)
(786) 294-0889
Entity
Organization
Contact information
Practice address
175 FONTAINEBLEAU BLVD, STE 1-C, MIAMI, FL 33172-7018
(786) 294-0889
(786) 362-6865
Mailing address
175 FONTAINEBLEAU BLVD, STE 1-C, MIAMI, FL 33172-7018
(786) 294-0889
(786) 362-6865
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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