Healthcare Provider Details

I. General information

NPI: 1326035767
Provider Name (Legal Business Name): GEORGE HUMBERTO BORDENAVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/07/2023
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 N KENDALL DR
MIAMI FL
33176-2299
US

IV. Provider business mailing address

8720 N KENDALL DR STE 115
MIAMI FL
33176-2208
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-2444
  • Fax: 305-446-7847
Mailing address:
  • Phone: 305-446-2444
  • Fax: 305-446-7847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0055836
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD0000036724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: