Healthcare Provider Details

I. General information

NPI: 1922210517
Provider Name (Legal Business Name): KENDALL OB GYN CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40 STREET SUITE 518
MIAMI FL
33175-3598
US

IV. Provider business mailing address

11760 SW 40 STREET SUITE 518
MIAMI FL
33175-3598
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-2888
  • Fax: 305-553-0291
Mailing address:
  • Phone: 305-553-2888
  • Fax: 305-553-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TOMAS I MARIMON
Title or Position: PRESIDENT
Credential: MD
Phone: 305-553-2888