Healthcare Provider Details

I. General information

NPI: 1164010245
Provider Name (Legal Business Name): EASTERN MEDICAL KENDALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 N KENDALL DR STE 307
MIAMI FL
33176-1031
US

IV. Provider business mailing address

11410 N KENDALL DR STE 307
MIAMI FL
33176-1031
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-2227
  • Fax: 305-239-9227
Mailing address:
  • Phone: 305-279-2227
  • Fax: 305-239-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YOANDY CABRERA
Title or Position: CEO
Credential:
Phone: 786-925-7949