| Red Road Center Of South Florida Inc | |
|
1350 Sw 57th Ave Ste 315 West Miami FL 33144-5774 | |
| (786) 260-4727 | |
| Not Available |
| Full Name | Red Road Center Of South Florida Inc |
|---|---|
| Speciality | General Practice |
| Location | 1350 Sw 57th Ave Ste 315, West Miami, Florida |
| Authorized Official Name and Position | Maricela Gonzalez (OWNER) |
| Authorized Official Contact | 3057738173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Red Road Center Of South Florida Inc 1350 Sw 57th Ave Ste 315 West Miami FL 33144-5774 Ph: () - | Red Road Center Of South Florida Inc 1350 Sw 57th Ave Ste 315 West Miami FL 33144-5774 Ph: (786) 260-4727 |
| NPI Number | 1851983993 |
|---|---|
| Provider Enumeration Date | 02/10/2021 |
| Last Update Date | 08/15/2023 |
| Certification Date | 08/15/2023 |
| Medicare PECOS PAC ID | 2264876051 |
|---|---|
| Medicare Enrollment ID | O20240220003829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851983993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Omar Abreu-pino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891190526 PECOS PAC ID: 1850467820 Enrollment ID: I20150319001926 |
| Provider Name | Juan C Ruiz Bergon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457968968 PECOS PAC ID: 1254743271 Enrollment ID: I20201231001346 |
| Provider Name | Bledar Haxhiu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629538442 PECOS PAC ID: 6002141223 Enrollment ID: I20211111000385 |
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