Healthcare Provider Details

I. General information

NPI: 1487726063
Provider Name (Legal Business Name): SOUTH BEACH MATERNITY ASSOCOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NE 119TH STREET
MIAMI FL
33161
US

IV. Provider business mailing address

140 NE 119TH STREET
MIAMI FL
33161
US

V. Phone/Fax

Practice location:
  • Phone: 305-754-2229
  • Fax: 305-754-2212
Mailing address:
  • Phone: 305-754-2229
  • Fax: 305-754-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number319
License Number StateFL

VIII. Authorized Official

Name: MS. CAROL DEE WILLIAMS
Title or Position: OWNER
Credential: LM
Phone: 305-754-2229