Healthcare Provider Details

I. General information

NPI: 1609190412
Provider Name (Legal Business Name): FORMAR ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 CORAL WAY STE 204
MIAMI FL
33155-1758
US

IV. Provider business mailing address

6850 CORAL WAY STE 204
MIAMI FL
33155-1758
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-9503
  • Fax:
Mailing address:
  • Phone: 305-859-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: IRENE MARTINEZ
Title or Position: OWNER
Credential: OTR/L
Phone: 305-859-9503