Healthcare Provider Details

I. General information

NPI: 1043251994
Provider Name (Legal Business Name): MIAMI HORIZON CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SW 56ST STE 33
MIAMI FL
33165
US

IV. Provider business mailing address

10000 SW 56ST STE 33
MIAMI FL
33165
US

V. Phone/Fax

Practice location:
  • Phone: 786-534-8080
  • Fax: 786-615-4636
Mailing address:
  • Phone: 786-534-8080
  • Fax: 786-615-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 39744
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9326
License Number StateFL

VIII. Authorized Official

Name: MRS. OLGA SURI
Title or Position: PRESIDENT
Credential:
Phone: 786-586-6060