Provider Demographics
NPI:1871286716
Name:SAGITTARIUS EDCARE, INC
Entity type:Organization
Organization Name:SAGITTARIUS EDCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-491-2234
Mailing Address - Street 1:11 ISLAND AVE APT 810
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1323
Mailing Address - Country:US
Mailing Address - Phone:305-491-2234
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 37TH AVE STE 505
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2750
Practice Address - Country:US
Practice Address - Phone:305-514-0861
Practice Address - Fax:305-521-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care