Healthcare Provider Details

I. General information

NPI: 1356757298
Provider Name (Legal Business Name): FLORIDA INTERNATIONAL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SW 113TH AVE ARENA ROOM 156
MIAMI FL
33174
US

IV. Provider business mailing address

1180 SW 113TH AVE ARENA ROOM 156
MIAMI FL
33174
US

V. Phone/Fax

Practice location:
  • Phone: 800-555-9073
  • Fax: 972-367-3452
Mailing address:
  • Phone: 800-555-9073
  • Fax: 972-367-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE BERG
Title or Position: SR. ASSOCIATE ATHLETIC DIRECTOR
Credential:
Phone: 305-348-2352