Healthcare Provider Details

I. General information

NPI: 1740792597
Provider Name (Legal Business Name): FLORIDA MEDICAL SOLUTIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 SW 138TH PL
MIAMI FL
33186-7872
US

IV. Provider business mailing address

9521 SW 138TH PL
MIAMI FL
33186-7872
US

V. Phone/Fax

Practice location:
  • Phone: 786-357-9940
  • Fax:
Mailing address:
  • Phone: 786-357-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPENDING
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AMADOR REYES
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-253-7699