Healthcare Provider Details

I. General information

NPI: 1619588324
Provider Name (Legal Business Name): MIAMI LAKES DOCTOR'S LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5779 NW 151ST ST
MIAMI LAKES FL
33014-2483
US

IV. Provider business mailing address

5757 NW 151ST ST
MIAMI LAKES FL
33014-2482
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2058
  • Fax: 786-353-2087
Mailing address:
  • Phone: 786-353-2058
  • Fax: 786-353-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YUSNIEL ROMERO TORRES
Title or Position: PRESIDENT
Credential:
Phone: 786-299-6333