Blue Lagoon Medical Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLUE LAGOON MEDICAL CENTER INC

Practice address

4355 W 16TH Ave Ste 211a
Hialeah, FL 33012-7670

Phone

(786) 304-9107

Fax

(786) 364-0230

NPI assigned

Jul 7, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ricardo Montpeller Acosta, MA

Title

President

Phone

(786) 304-9107

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1083097281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 W 16TH AVE STE 211A",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330127670",
            "telephone_number": "786-304-9107",
            "fax_number": "786-364-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 W 16TH AVE STE 211A",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330127670",
            "telephone_number": "786-304-9107",
            "fax_number": "786-364-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LAGOON MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "MONTPELLER ACOSTA",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-304-9107",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.