Healthcare Provider Details

I. General information

NPI: 1417612243
Provider Name (Legal Business Name): KIDNEY SPECIALTY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 760
MIAMI BEACH FL
33140-2893
US

IV. Provider business mailing address

219 NW 12TH AVE STE C-5
MIAMI FL
33128-2205
US

V. Phone/Fax

Practice location:
  • Phone: 305-548-4063
  • Fax: 305-545-1515
Mailing address:
  • Phone: 305-548-4063
  • Fax: 305-545-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE GARCIA
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 305-606-0337