Organization
MEDISANA HEALTH CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLEIDYS SOTO ALONSO (OWNER)
(305) 799-3112
Entity
Organization
Contact information
Practice address
5391 NW 36TH ST, MIAMI SPRINGS, FL 33166-5924
(786) 636-1310
(786) 636-1311
Mailing address
5391 NW 36TH ST, MIAMI SPRINGS, FL 33166-5924
(786) 636-1310
(786) 636-1311
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
364SP0812X
Community Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109165700
—
FL
Enumeration date
11/19/2020
Last updated
12/18/2024
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