Fardales Medical Center Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

PA9103093 Issued in FL

Legal business name

FARDALES MEDICAL CENTER INC

Practice address

8051 W 24TH Ave Ste 9
Hialeah, FL 33016-5596

Phone

(305) 400-9702

Fax

(305) 397-2165

NPI assigned

Aug 27, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Maricela Dianexi Fardales, P.A.NPI 1457362410

Title

Owner

Phone

(305) 400-9702

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maricela Dianexi Fardales, PA

  • Medical Physician Assistant
  • Hialeah, FL
  • NPI 1457362410
  Medicare reassignment Authorized official
• Altagracia Adalgiza Victoria, M.D.

  • Family Medicine Physician
  • Miami Lakes, FL
  • NPI 1649220898
  NPD

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1174990915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8051 W 24TH AVE STE 9",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165596",
            "telephone_number": "305-400-9702",
            "fax_number": "305-735-7542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8051 W 24TH AVE STE 9",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165596",
            "telephone_number": "305-400-9702",
            "fax_number": "305-397-2165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1806 N Flamingo Rd Ste 180",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330281029",
            "country_code": "US",
            "telephone_number": "305-400-9702",
            "fax_number": "305-735-7542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FARDALES MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-27",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "FARDALES",
        "authorized_official_first_name": "MARICELA",
        "authorized_official_middle_name": "DIANEXI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-400-9702",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "PA9103093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004570500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Victoria Faraci, M.D.
• Maricela Faraco Collazo
• Farah Michelle Alf, Inc
• Farali Home for Erderly, Inc.
• Fardales Home Alf
• Maricela Dianexi Fardales, PA
• Farid Marquez, M.D., P.a.
• Dania Farigola, TCM SUPERVISOR
• Salomon Eli Farin, PHARM.D.
• Maria del Mar Farinas

• Primary Care Clinic/Center in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.