Healthcare Provider Details

I. General information

NPI: 1740401199
Provider Name (Legal Business Name): MVDR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 NW 27TH AVE SUITE 309-2
MIAMI FL
33125-5127
US

IV. Provider business mailing address

42 NW 27TH AVE SUITE 309-2
MIAMI FL
33125-5127
US

V. Phone/Fax

Practice location:
  • Phone: 786-507-3846
  • Fax: 305-403-2347
Mailing address:
  • Phone: 786-507-3846
  • Fax: 305-403-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberPENDING
License Number StateFL

VIII. Authorized Official

Name: MANUEL FERNANDEZ-VILLADEREY
Title or Position: PRESIDENT
Credential: CRT
Phone: 786-507-3846