Organization
CHEN NEIGHBORHOOD MEDICAL OF SOUTH LAKELAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DINA VALLADARES (MANAGER OF CREDENTIALING)
(305) 831-4760
Entity
Organization
Contact information
Practice address
4715 S FLORIDA AVE, LAKELAND, FL 33813-2101
(305) 628-6117
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5742
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
03/23/2016
Last updated
06/01/2016
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