Healthcare Provider Details

I. General information

NPI: 1982304713
Provider Name (Legal Business Name): 9AMHEALTH MEDICAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 MERIDIAN AVE STE 600&700
MIAMI BEACH FL
33139-2710
US

IV. Provider business mailing address

914 N COAST HIGHWAY 101 STE A
ENCINITAS CA
92024-2074
US

V. Phone/Fax

Practice location:
  • Phone: 202-932-9958
  • Fax:
Mailing address:
  • Phone: 202-932-9958
  • Fax: 844-927-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DISTEFANO
Title or Position: OPERATIONS MANAGER
Credential: PHARMD
Phone: 202-932-9958