Healthcare Provider Details

I. General information

NPI: 1700761020
Provider Name (Legal Business Name): ABIGAIL RUBEN BRACAMONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

2186 W 60TH ST APT 20102
HIALEAH FL
33016-7712
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-7155
  • Fax:
Mailing address:
  • Phone: 786-417-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberPS69234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: