MEDICARE: NOSTRUM THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316691074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOSTRUM THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	10383 SW 186TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-6824
Country	:	US
Telephone Number	:	786-216-8690
Fax Number	:	305-964-5203

Provider Business Practice Location Address
First Line	:	10383 SW 186TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-6824
Country	:	US
Telephone Number	:	786-216-8690
Fax Number	:	305-964-5203

Authorized Official
Title or Position	:	OWNER
Name	:	TOMAS GARCIA PEREZ
Credential	:
Telephone Number	:	786-216-8690

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “NOSTRUM THERAPY SERVICES LLC ” Practice Location

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