Healthcare Provider Details

I. General information

NPI: 1639446503
Provider Name (Legal Business Name): FAITH HEALTH PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 SW 42ND ST SUITE 101
MIAMI FL
33175-2905
US

IV. Provider business mailing address

12905 SW 42ND ST SUITE 101
MIAMI FL
33175-2905
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-4787
  • Fax: 305-220-4786
Mailing address:
  • Phone: 305-220-4787
  • Fax: 305-220-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66384
License Number StateFL

VIII. Authorized Official

Name: RENE ROBERTO ANDINO
Title or Position: PREIDENT
Credential: MD
Phone: 305-220-4787