Healthcare Provider Details

I. General information

NPI: 1538437017
Provider Name (Legal Business Name): OCEAN BLUE MEDICAL RESEARCH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

IV. Provider business mailing address

286 WESTWARD DR
MIAMI SPRINGS FL
33166-5260
US

V. Phone/Fax

Practice location:
  • Phone: 305-885-8983
  • Fax: 305-885-8984
Mailing address:
  • Phone: 305-885-8983
  • Fax: 305-885-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. YANET RODRIGUEZ FERRERA
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 305-885-8983