Healthcare Provider Details

I. General information

NPI: 1245499631
Provider Name (Legal Business Name): MI SUBLIME ATARDECER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20630 NW 37 CT.
MIAMI GARDENS FL
33055
US

IV. Provider business mailing address

20630 NW 37 CT.
MIAMI GARDENS FL
33055
US

V. Phone/Fax

Practice location:
  • Phone: 305-760-2653
  • Fax: 305-628-6158
Mailing address:
  • Phone: 305-760-2653
  • Fax: 305-628-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PEDRO A ROMANACH LEIVA
Title or Position: OWNER
Credential:
Phone: 786-547-3749