Healthcare Provider Details

I. General information

NPI: 1639003783
Provider Name (Legal Business Name): BLUE FLORIDA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SW 87TH AVE STE 202
MIAMI FL
33165-5473
US

IV. Provider business mailing address

3850 SW 87TH AVE STE 202
MIAMI FL
33165-5473
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-9962
  • Fax: 786-542-9994
Mailing address:
  • Phone: 786-542-9962
  • Fax: 786-542-9994

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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR YZQUIERDO CHAVEZ
Title or Position: AMBR
Credential:
Phone: 786-474-8673