Healthcare Provider Details

I. General information

NPI: 1629790340
Provider Name (Legal Business Name): BKB MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13814 SW 152ND ST
MIAMI FL
33177-1164
US

IV. Provider business mailing address

13814 SW 152ND ST
MIAMI FL
33177-1164
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-1002
  • Fax: 305-402-7714
Mailing address:
  • Phone: 305-305-1002
  • Fax: 305-402-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YANET GARCIA
Title or Position: APRN
Credential: APRN
Phone: 305-305-1002