Organization
PONCE MEDICLUB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LOPEZ (DIRECTOR OF OPERATIONS MED CTR)
(305) 992-4521
Entity
Organization
Contact information
Practice address
9950 SW 107TH AVE STE 203, MIAMI, FL 33176-2767
(305) 908-3144
(407) 605-5129
Mailing address
11455 SW 40TH ST # 146, MIAMI, FL 33165-3311
(305) 908-3144
(407) 605-5129
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/03/2019
Last updated
05/12/2022
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