Med Lake Center LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

HCC11818 Issued in FL

Legal business name

MED LAKE CENTER LLC

Practice address

16371 NW 67TH Ave
Miami Lakes, FL 33014-6044

Phone

(786) 332-4991

Fax

(786) 409-2037

NPI assigned

Jun 30, 2015

Last updated

Oct 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mayra Lourdes Zeno, MD

Title

Medical Director

Phone

(786) 332-4991

Specialties & licenses 1

Addresses

Other names 1

• G & I Medical Research Former legal business name

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1518340124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16371 NW 67TH AVE",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146044",
            "telephone_number": "786-332-4991",
            "fax_number": "786-409-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16371 NW 67TH AVE",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146044",
            "telephone_number": "786-332-4991",
            "fax_number": "786-409-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED LAKE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "ZENO",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "LOURDES",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "786-332-4991",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "HCC11818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "G & I Medical Research",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• General Practice Physician in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.