Healthcare Provider Details

I. General information

NPI: 1700331709
Provider Name (Legal Business Name): CHEBERE APPETITE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 NW 167TH ST
MIAMI LAKES FL
33014-6427
US

IV. Provider business mailing address

4720 NW 167TH ST
MIAMI LAKES FL
33014-6427
US

V. Phone/Fax

Practice location:
  • Phone: 305-454-1900
  • Fax:
Mailing address:
  • Phone: 305-454-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberSEA2332781
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License NumberSEA2332781
License Number StateFL

VIII. Authorized Official

Name: RICARDO GONZALEZ
Title or Position: COO
Credential:
Phone: 305-454-1900