MEDICARE: NEOSTART CORP

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	261QR1100X	Research Clinic/Center	OS8448	FL

General Provider Information

NPI Number	:	1922376201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOSTART CORP

Provider Business Mailing Address
First Line	:	900 W 49TH ST
Second Line	:	SUITE #430
City	:	HIALEAH
State	:	FL
Zip	:	33012-3402
Country	:	US
Telephone Number	:	305-819-1551
Fax Number	:	305-819-1159

Provider Business Practice Location Address
First Line	:	900 W 49TH ST
Second Line	:	SUITE #430
City	:	HIALEAH
State	:	FL
Zip	:	33012-3402
Country	:	US
Telephone Number	:	305-819-1551
Fax Number	:	305-819-1159

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. MARIA XIMENA GRABER
Credential	:	M.D
Telephone Number	:	305-819-1551

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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Directions to “NEOSTART CORP ” Practice Location

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