Healthcare Provider Details

I. General information

NPI: 1942743034
Provider Name (Legal Business Name): ALVIN HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NE 199TH ST APT 201
MIAMI FL
33179-5841
US

IV. Provider business mailing address

925 NE 199TH ST # SY
MIAMI FL
33179-5841
US

V. Phone/Fax

Practice location:
  • Phone: 305-156-9947
  • Fax: 305-756-9948
Mailing address:
  • Phone: 305-156-9947
  • Fax: 305-756-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPTA 17986
License Number StateFL

VIII. Authorized Official

Name: ALVIN HILL
Title or Position: OWNER
Credential:
Phone: 305-303-0156