Healthcare Provider Details

I. General information

NPI: 1679304570
Provider Name (Legal Business Name): CENTERS OF MEDICAL EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15529 BULL RUN RD.
MIAMI LAKES FL
33014-7004
US

IV. Provider business mailing address

7925 NW 12 STREET SUITE 201
DORAL FL
33126-1821
US

V. Phone/Fax

Practice location:
  • Phone: 305-328-8922
  • Fax: 786-224-6489
Mailing address:
  • Phone: 305-874-3909
  • Fax: 305-874-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SADITA BUSTAMANTE
Title or Position: COO
Credential:
Phone: 305-874-3909