Healthcare Provider Details

I. General information

NPI: 1003536095
Provider Name (Legal Business Name): MIAMI DADE MEDICAL RESEARCH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SW 87TH CT STE 112
MIAMI FL
33176-2264
US

IV. Provider business mailing address

8955 SW 87TH CT STE 112
MIAMI FL
33176-2264
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-7210
  • Fax: 786-513-5923
Mailing address:
  • Phone: 305-722-7210
  • Fax: 786-513-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ONELIA FAJARDO
Title or Position: PRESIDENT
Credential:
Phone: 305-722-7210