Healthcare Provider Details

I. General information

NPI: 1982998597
Provider Name (Legal Business Name): CLINICA VENAMER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 NW 25TH ST UNIT 114
DORAL FL
33172-5921
US

IV. Provider business mailing address

10200 NW 25TH ST UNIT 114
DORAL FL
33172-5921
US

V. Phone/Fax

Practice location:
  • Phone: 305-482-9556
  • Fax: 305-482-9557
Mailing address:
  • Phone: 305-482-9556
  • Fax: 305-482-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC9551
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberHCC9153
License Number StateFL

VIII. Authorized Official

Name: GIANPAOLO BELMONTE
Title or Position: MANAGER
Credential:
Phone: 305-482-9556