Healthcare Provider Details

I. General information

NPI: 1558002873
Provider Name (Legal Business Name): RETREAT MEDICAL RESEARCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 04/02/2022
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 WEST FLAGLER ST
MIAMI FL
33135-1915
US

IV. Provider business mailing address

1818 WEST FLAGLER ST
MIAMI FL
33135-1915
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-3467
  • Fax:
Mailing address:
  • Phone: 855-500-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: ADIEL TAPANES
Title or Position: ADMINISTRATOR
Credential:
Phone: 855-500-3467