Healthcare Provider Details

I. General information

NPI: 1144654625
Provider Name (Legal Business Name): STEM CELL MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 GALLOWAY RD SUITE 109
MIAMI FL
33173-2500
US

IV. Provider business mailing address

6401 GALLOWAY RD SUITE 109
MIAMI FL
33173-2500
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-7777
  • Fax: 305-598-7775
Mailing address:
  • Phone: 305-598-7777
  • Fax: 305-598-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3517
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME82708
License Number StateFL

VIII. Authorized Official

Name: MARIA CASTANEDA
Title or Position: OWNER
Credential:
Phone: 305-598-7777