Healthcare Provider Details

I. General information

NPI: 1558312314
Provider Name (Legal Business Name): UNIVERSITY OF MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-7688
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-7688
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: CESIA A SANCHEZ
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 305-243-6837