Healthcare Provider Details

I. General information

NPI: 1770380792
Provider Name (Legal Business Name): BOFILL SERVICES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6628 SW 113TH AVE # 6628
MIAMI FL
33173-1972
US

IV. Provider business mailing address

6628 SW 113TH AVE # 6628
MIAMI FL
33173-1972
US

V. Phone/Fax

Practice location:
  • Phone: 786-287-4343
  • Fax:
Mailing address:
  • Phone: 786-357-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MADELEYNE BOFILL
Title or Position: OWNER
Credential: RN
Phone: 786-357-7968