Provider Demographics
NPI:1609605328
Name:COSME MEDICAL CENTER LLC
Entity type:Organization
Organization Name:COSME MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COSME
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-543-7403
Mailing Address - Street 1:8742 SW 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5403
Mailing Address - Country:US
Mailing Address - Phone:786-543-7403
Mailing Address - Fax:
Practice Address - Street 1:8742 SW 161ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5403
Practice Address - Country:US
Practice Address - Phone:786-543-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care