Healthcare Provider Details

I. General information

NPI: 1194960526
Provider Name (Legal Business Name): MATHILDE LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 NE 2CT
MIAMI FL
33138-3928
US

IV. Provider business mailing address

8410 NE 2ND CT
MIAMI FL
33138-3928
US

V. Phone/Fax

Practice location:
  • Phone: 305-490-1304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberRT9180
License Number StateFL

VIII. Authorized Official

Name: MS. MATHILDE LOUIS
Title or Position: REGISTERED RESPIRATORY THERAPY
Credential:
Phone: 305-490-1304