Healthcare Provider Details

I. General information

NPI: 1699384248
Provider Name (Legal Business Name): FIESTA ADULT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 04/10/2023
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7816 NE 2ND AVE
MIAMI FL
33138-4805
US

IV. Provider business mailing address

18073 NW 74TH CT
HIALEAH FL
33015-8455
US

V. Phone/Fax

Practice location:
  • Phone: 786-326-6331
  • Fax:
Mailing address:
  • Phone: 786-326-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MELISSA HEVIA
Title or Position: CEO
Credential:
Phone: 786-204-2827