Healthcare Provider Details

I. General information

NPI: 1760218317
Provider Name (Legal Business Name): MD ON THE GO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 SALZEDO ST STE 202-Z
CORAL GABLES FL
33134-6722
US

IV. Provider business mailing address

3081 SALZEDO ST STE 202-Z
CORAL GABLES FL
33134-6722
US

V. Phone/Fax

Practice location:
  • Phone: 561-759-0043
  • Fax:
Mailing address:
  • Phone: 561-759-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA PEREA BARBOSA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-895-2091