Healthcare Provider Details

I. General information

NPI: 1275106049
Provider Name (Legal Business Name): AGAPE HEALTH PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 CORAL WAY STE 404
MIAMI FL
33155-1693
US

IV. Provider business mailing address

7171 CORAL WAY STE 404
MIAMI FL
33155-1693
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-0526
  • Fax:
Mailing address:
  • Phone: 305-434-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL I VALENZUELA JARAMILLO
Title or Position: OWNER
Credential:
Phone: 305-434-0526