Healthcare Provider Details

I. General information

NPI: 1184634818
Provider Name (Legal Business Name): BUENA VISTA MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 SW 46TH ST
MIAMI FL
33175-4739
US

IV. Provider business mailing address

11805 SW 46TH ST
MIAMI FL
33175-4739
US

V. Phone/Fax

Practice location:
  • Phone: 305-610-2526
  • Fax: 305-221-5224
Mailing address:
  • Phone: 305-610-2526
  • Fax: 305-221-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS A PEREZ
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 305-610-2526