Provider Demographics
NPI:1730805086
Name:LA SAGRADA FAMILIA MEDICAL CENTER
Entity type:Organization
Organization Name:LA SAGRADA FAMILIA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ BERGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-615-2843
Mailing Address - Street 1:7270 NW 12TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1941
Mailing Address - Country:US
Mailing Address - Phone:786-615-2843
Mailing Address - Fax:786-980-1607
Practice Address - Street 1:7270 NW 12TH ST STE 430
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1941
Practice Address - Country:US
Practice Address - Phone:786-615-2843
Practice Address - Fax:786-980-1607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA SAGRADA FAMILIA MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty