Provider Demographics
NPI:1548946445
Name:LA EDAD PREDIGIOSA COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:LA EDAD PREDIGIOSA COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATIRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-445-3446
Mailing Address - Street 1:18900 SW 106 AVE STE101-103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:786-445-3446
Mailing Address - Fax:
Practice Address - Street 1:18900 SW 106 AVE STE101-103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:786-445-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health