Healthcare Provider Details

I. General information

NPI: 1619703691
Provider Name (Legal Business Name): MEDVERSE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 CORAL WAY FL 3
MIAMI FL
33155-1758
US

IV. Provider business mailing address

6850 SW 24TH ST FL 3
MIAMI FL
33155-1758
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-4441
  • Fax: 305-265-4844
Mailing address:
  • Phone: 305-859-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KEILA HOOVER
Title or Position: OWNER
Credential: MD
Phone: 305-433-7419