MEDICARE: MEDICAL VISITS AT HOME, INC

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

General Provider Information

NPI Number	:	1942246442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL VISITS AT HOME, INC

Provider Business Mailing Address
First Line	:	2640 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4830
Country	:	US
Telephone Number	:	954-367-0616
Fax Number	:	954-367-0618

Provider Business Practice Location Address
First Line	:	2640 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4852
Country	:	US
Telephone Number	:	954-367-0616
Fax Number	:	954-367-0618

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VLADIMIR CANINO
Credential	:
Telephone Number	:	954-367-0616

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/22/2020

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