Organization
INTERNATIONAL MEDICAL CENTER HMO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY DE JESUS (OWNER)
(305) 644-0977
Entity
Organization
Contact information
Practice address
10 NW 42ND AVE, SUITE # 600, MIAMI, FL 33126-5473
(305) 644-0977
(305) 644-0114
Mailing address
10 NW 42ND AVE, SUITE # 600, MIAMI, FL 33126-5473
(305) 644-0977
(305) 644-0114
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
FL
Other
Enumeration date
03/03/2014
Last updated
07/21/2022
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