Healthcare Provider Details

I. General information

NPI: 1376204420
Provider Name (Legal Business Name): AMEDICAL LUXURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 41ST ST
HIALEAH FL
33013-2235
US

IV. Provider business mailing address

117 E 41ST ST
HIALEAH FL
33013-2235
US

V. Phone/Fax

Practice location:
  • Phone: 786-407-4103
  • Fax:
Mailing address:
  • Phone: 786-407-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER ALEXANDRA PRECIADO
Title or Position: CEO/PRACTITIONER
Credential: FNP-C
Phone: 786-362-4338