Healthcare Provider Details

I. General information

NPI: 1407464845
Provider Name (Legal Business Name): DYNAMIC MEDICAL RESEARCH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 W FLAGLER ST
MIAMI FL
33144-3363
US

IV. Provider business mailing address

5872 W FLAGLER ST
MIAMI FL
33144-3363
US

V. Phone/Fax

Practice location:
  • Phone: 888-367-2155
  • Fax: 888-317-1733
Mailing address:
  • Phone: 888-367-2155
  • Fax: 888-317-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE A GARCIA
Title or Position: CREDENTIALING
Credential: DIRECTOR
Phone: 888-367-2155