Healthcare Provider Details

I. General information

NPI: 1669419529
Provider Name (Legal Business Name): MARSHALL AMAYA & ANTON P L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

5901 SW 74TH ST SUITE 202
MIAMI FL
33143-5165
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone: 305-665-4614
  • Fax: 305-667-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. XAVIER ANTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-854-4400