BUENAVENTURA MEDICAL CENTER INC
Marriage and Family Therapists at 112 St, Miami, FL

License number
Florida HCC6910
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: MICHAEL MARTI
Title: PRESIDENT
Phone: (305) 274-7335
Address
Address
12305 SW 112Th St, Miami, FL 33186
National Provider ID: 1306893011
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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BUENAVENTURA MEDICAL CENTER INC

Miami, FL

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Oct 13, 2005
Inactive since:
Sep 26, 2008
Addresses:
12305 SW 112 St, Miami, FL 33186 (Physical)
13814 SW 149 Cir Ln APARTMENT # 4, Miami, FL 33186 (Mailing)
State ID:
P05000140147
Business type:
Florida Profit Corporation
President, Secretary, Director:
Alexander Castillo President, Secretary, Director, inactive
Agent:
Castillo, Alexander
EIN:
203639822

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