Healthcare Provider Details

I. General information

NPI: 1205111382
Provider Name (Legal Business Name): REGENCY VEIN CENTER OF MIAMI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 N KENDALL DR SUITE 214
MIAMI FL
33176-1029
US

IV. Provider business mailing address

11400 N KENDALL DR SUITE 214
MIAMI FL
33176-1029
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-5511
  • Fax: 305-273-6622
Mailing address:
  • Phone: 305-273-5511
  • Fax: 305-273-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ENRIQUE Z FRAGA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-273-5511