Illumina Medical Group Management, LLC

NPI #1104335314 in Doral, Florida

Provider Information

NPI Number: 1104335314
Entity Type: Organization
Organization Name: Illumina Medical Group Management, LLC
Primary Specialty: Clinic/Center
Enumeration Date: Sep 20, 2017
Last Updated: Jul 21, 2022

Practice Location

Address: 1914 NW 84TH AVE
City: Doral
State: Florida
ZIP Code: 33126-1030
Phone: (305) 254-8900

Authorized Official

Name: ANGEL MONGEOTTI
Title: EXECUTIVE DIRECTOR OF FINANCE
Phone: (305) 254-8900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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