Healthcare Provider Details

I. General information

NPI: 1376704775
Provider Name (Legal Business Name): NEUROLOGY-NEUROSURGERY OF DADE AND BROWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 315
HIALEAH FL
33016-1811
US

IV. Provider business mailing address

18520 NW 67TH AVE SUITE 112
HIALEAH FL
33015-3302
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-6201
  • Fax: 305-557-6203
Mailing address:
  • Phone: 305-557-6201
  • Fax: 305-557-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME89140
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME89140
License Number StateFL

VIII. Authorized Official

Name: MRS. JULIETTE S CORTES
Title or Position: OWNER
Credential:
Phone: 305-394-8594