Organization
ALTIUS MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALIAN HERNANDEZ LOPEZ MD (AUTHORIZED OFFICIAL)
(305) 988-5000
Entity
Organization
Contact information
Practice address
14221 SW 120TH ST STE 129, MIAMI, FL 33186-7463
(786) 292-9650
(786) 420-3240
Mailing address
14221 SW 120TH ST STE 129, MIAMI, FL 33186-7463
(786) 292-9650
(786) 420-3240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ID
55555
FL
Enumeration date
09/06/2022
Last updated
08/29/2024
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