Healthcare Provider Details

I. General information

NPI: 1821332073
Provider Name (Legal Business Name): MH IMPERIAL SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 SW 107TH AVE # 264
MIAMI FL
33174-2526
US

IV. Provider business mailing address

1421 SW 107TH AVE # 264
MIAMI FL
33174-2526
US

V. Phone/Fax

Practice location:
  • Phone: 786-334-2585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISLEIDA HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-334-2585