Healthcare Provider Details

I. General information

NPI: 1609033455
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS @ MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

665 NE 195TH ST APT 227
NORTH MIAMI BEACH FL
33179-3339
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 305-999-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberRN3285222
License Number StateFL

VIII. Authorized Official

Name: MS. MARY D BERROCAL
Title or Position: DIRECTOR
Credential: MBA
Phone: 305-575-7000