Healthcare Provider Details

I. General information

NPI: 1982932422
Provider Name (Legal Business Name): DVAMC MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST MAILSTOP 112
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST MAILSTOP 112
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-7234
Mailing address:
  • Phone: 305-575-7000
  • Fax: 305-575-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberPR174
License Number StateFL

VIII. Authorized Official

Name: DR. NATHAN DANIEL VELA
Title or Position: PODIATRIC SURGICAL RESIDENT
Credential: D.P.M.
Phone: 305-575-7000