Provider Demographics
NPI:1730523390
Name:OPAC HEALTH CARE CORP
Entity type:Organization
Organization Name:OPAC HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-260-5101
Mailing Address - Street 1:15160 SW 136TH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2662
Mailing Address - Country:US
Mailing Address - Phone:786-260-5101
Mailing Address - Fax:786-221-4087
Practice Address - Street 1:15160 SW 136TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2662
Practice Address - Country:US
Practice Address - Phone:786-260-5101
Practice Address - Fax:786-221-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP1300029815OtherCOMM INS