Healthcare Provider Details

I. General information

NPI: 1831609684
Provider Name (Legal Business Name): ACCESS MEDICAL GROUP OF TAMPA III, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 05/01/2024
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 HAVENDALE BLVD
AUBURNDALE FL
33823-4527
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 863-327-0131
  • Fax: 863-777-2307
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYNY RAMIREZ
Title or Position: PRESIDENT
Credential:
Phone: 786-322-7333