Healthcare Provider Details

I. General information

NPI: 1336596287
Provider Name (Legal Business Name): BILLART MED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 W 24TH AVE APT 205
HIALEAH FL
33016-6983
US

IV. Provider business mailing address

6333 W 24TH AVE APT 205
HIALEAH FL
33016-6983
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-0232
  • Fax:
Mailing address:
  • Phone: 305-202-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM VIDAL
Title or Position: PRESIDENT
Credential:
Phone: 305-202-0232