Healthcare Provider Details

I. General information

NPI: 1568775963
Provider Name (Legal Business Name): DYNAMIC PROFESSIONAL TREATMENTS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 SW 137TH AVE
MIAMI FL
33175-6330
US

IV. Provider business mailing address

2470 SW 137TH AVE
MIAMI FL
33175-6330
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-0697
  • Fax: 305-675-2668
Mailing address:
  • Phone: 786-419-0697
  • Fax: 305-675-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC8364
License Number StateFL

VIII. Authorized Official

Name: YOANDRA ACOSTA
Title or Position: PRESIDENT
Credential:
Phone: 786-419-0697