Organization
ST JUDE MEDICAL GROUP CORP
Active
Other names
VIDAMAX MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL D. GONZALEZ MD (MEDICAL DIRECTOR)
(786) 464-5120
Entity
Organization
Contact information
Practice address
11300 NW 87TH CT STE 141, HIALEAH GARDENS, FL 33018-4520
(786) 464-5120
(786) 464-5125
Mailing address
2141 NW 7TH ST, MIAMI, FL 33125-3483
(786) 464-5120
(786) 464-5125
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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