Healthcare Provider Details

I. General information

NPI: 1679492664
Provider Name (Legal Business Name): MEDIVANTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 252
DORAL FL
33122-1087
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 252
DORAL FL
33122-1087
US

V. Phone/Fax

Practice location:
  • Phone: 305-942-8511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MCLAREN
Title or Position: ORGANIZER
Credential:
Phone: 305-942-8511