Provider Demographics
NPI:1902174923
Name:ALZUGARAY THERAPY CENTER INC
Entity Type:Organization
Organization Name:ALZUGARAY THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZUGARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-874-3881
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-874-3881
Mailing Address - Fax:
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-874-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64489261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM28235OtherSTATE LICENSE