Healthcare Provider Details

I. General information

NPI: 1659990364
Provider Name (Legal Business Name): PROVECTUS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 N KENDALL DR STE 215
MIAMI FL
33156-7758
US

IV. Provider business mailing address

1430 S DIXIE HWY STE 1080
CORAL GABLES FL
33146-3176
US

V. Phone/Fax

Practice location:
  • Phone: 786-422-5223
  • Fax:
Mailing address:
  • Phone: 786-422-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALDO GONZALEZ-BEICOS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 786-422-5223