Healthcare Provider Details

I. General information

NPI: 1659005858
Provider Name (Legal Business Name): A&B CLINIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10651 N KENDALL DR STE 217
MIAMI FL
33176-1545
US

IV. Provider business mailing address

10651 N KENDALL DR STE 217
MIAMI FL
33176-1545
US

V. Phone/Fax

Practice location:
  • Phone: 786-461-9549
  • Fax:
Mailing address:
  • Phone: 786-461-9549
  • Fax:

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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO PENA BELLO
Title or Position: OWNER
Credential: APRN/FNP
Phone: 786-461-9549