Healthcare Provider Details

I. General information

NPI: 1457650087
Provider Name (Legal Business Name): MANUEL RENE SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 68TH ST STE A
HIALEAH FL
33014-4597
US

IV. Provider business mailing address

1301 W 68 ST SUITE A
HIALEAH FL
33014
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-2006
  • Fax:
Mailing address:
  • Phone: 305-822-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number266026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: