MEDICARE: KRYSTAL BITTAR 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	314000000X	Skilled Nursing Facility	PY8352	FL

General Provider Information

NPI Number	:	1821438953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRYSTAL BITTAR LLC

Provider Business Mailing Address
First Line	:	2622 SW 32ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2804
Country	:	US
Telephone Number	:	305-951-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2622 SW 32ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2804
Country	:	US
Telephone Number	:	305-951-1116
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KRYSTAL BITTAR
Credential	:	PSY.D.
Telephone Number	:	305-919-8099

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/03/2013

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