Healthcare Provider Details

I. General information

NPI: 1871424051
Provider Name (Legal Business Name): FLAVIO BALLERINI SOUZA-CAMPOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

10 CANAL ST # 234
MIAMI SPRINGS FL
33166-4404
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-3279
  • Fax:
Mailing address:
  • Phone: 305-505-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHSE44096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: