Organization
NACIDOS EN DIVINA MICEROCORDIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNY I TORRES (CHEIF OF OPERATION)
(813) 662-4808
Entity
Organization
Contact information
Practice address
315 S US HIGHWAY 41, RUSKIN, FL 33570-4660
(813) 662-4808
Mailing address
315 US HIGHWAY SOUTH 41, RUSKIN, FL 33570
(813) 662-4808
(813) 649-8323
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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