Healthcare Provider Details

I. General information

NPI: 1922954015
Provider Name (Legal Business Name): AVANTI CLINICAL RESEARCH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 214
HIALEAH FL
33013-3850
US

IV. Provider business mailing address

777 E 25TH ST STE 214
HIALEAH FL
33013-3850
US

V. Phone/Fax

Practice location:
  • Phone: 786-755-4815
  • Fax: 786-755-4821
Mailing address:
  • Phone: 786-755-4815
  • Fax: 786-755-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSE E VILLASUSO MORALES
Title or Position: OWNER
Credential: DNP, APRN- FNP
Phone: 786-755-4815