Healthcare Provider Details

I. General information

NPI: 1114319266
Provider Name (Legal Business Name): VARADERO MEDICAL RESEARCH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 W FLAGLER ST
MIAMI FL
33144-3363
US

IV. Provider business mailing address

5850 W FLAGLER ST
MIAMI FL
33144-3363
US

V. Phone/Fax

Practice location:
  • Phone: 305-263-9590
  • Fax: 305-263-9657
Mailing address:
  • Phone: 305-263-9590
  • Fax: 305-263-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number15000018030
License Number StateFL

VIII. Authorized Official

Name: DEMIS ALEXANDER EXPOSITO
Title or Position: CEO
Credential:
Phone: 305-263-9590