Healthcare Provider Details

I. General information

NPI: 1124473061
Provider Name (Legal Business Name): LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 HAMMOCKS BLVD
MIAMI FL
33193-4172
US

IV. Provider business mailing address

700 SW 8TH ST
MIAMI FL
33130-3311
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-0887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9342
License Number StateFL

VIII. Authorized Official

Name: MR. RAFAEL IGLESIAS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 305-858-0887