Healthcare Provider Details

I. General information

NPI: 1861469702
Provider Name (Legal Business Name): CMS MIAMI SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE COTTAGE #5
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE COTTAGE #5
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-2490
  • Fax: 786-624-5790
Mailing address:
  • Phone: 786-624-2490
  • Fax: 786-624-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. CARMEN LOPEZ
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 305-349-1330