Healthcare Provider Details

I. General information

NPI: 1962933697
Provider Name (Legal Business Name): BETEAL GETACHEW ASHINNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1120 NW 14TH ST, 11TH FLOOR SUITE 1123
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME164293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: