Healthcare Provider Details

I. General information

NPI: 1972554442
Provider Name (Legal Business Name): UNIVERSITY OF MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1601 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-7688
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-7688
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CESIA A SANCHEZ
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 305-243-6837