Healthcare Provider Details

I. General information

NPI: 1912838681
Provider Name (Legal Business Name): EPILEPSY & BRAIN CENTER OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NE 213TH ST STE 1211
AVENTURA FL
33180-1267
US

IV. Provider business mailing address

601 NE 39TH ST APT 311
MIAMI FL
33137-3733
US

V. Phone/Fax

Practice location:
  • Phone: 954-213-7475
  • Fax:
Mailing address:
  • Phone: 954-213-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAMILO IVAN GARCIA GRACIA
Title or Position: DIRECTOR
Credential: MD
Phone: 954-213-7475