Provider Demographics
NPI:1730383480
Name:MEDCHOICE OF OPALOCKA L L C
Entity type:Organization
Organization Name:MEDCHOICE OF OPALOCKA L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-398-0807
Mailing Address - Street 1:1980 OPA LOCKA BLVD
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-4226
Mailing Address - Country:US
Mailing Address - Phone:305-405-8800
Mailing Address - Fax:305-685-2594
Practice Address - Street 1:1980 OPA LOCKA BLVD
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-4226
Practice Address - Country:US
Practice Address - Phone:305-398-0807
Practice Address - Fax:305-269-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty