Provider Demographics
NPI:1538853395
Name:MEDTOUR LLC
Entity type:Organization
Organization Name:MEDTOUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-780-1180
Mailing Address - Street 1:10305 NW 41ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2982
Mailing Address - Country:US
Mailing Address - Phone:786-780-1180
Mailing Address - Fax:305-356-3617
Practice Address - Street 1:10305 NW 41ST ST STE 203
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2982
Practice Address - Country:US
Practice Address - Phone:786-780-1180
Practice Address - Fax:305-356-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care