Healthcare Provider Details

I. General information

NPI: 1477618387
Provider Name (Legal Business Name): DEPARTMENT OF VA, MIAMI VA HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12530 NE 1ST
MIAMI FL
33161
US

IV. Provider business mailing address

12530 NE 1ST CT
NORTH MIAMI FL
33161-4551
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-2974
  • Fax:
Mailing address:
  • Phone: 305-807-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number9235377
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number9235377
License Number StateFL

VIII. Authorized Official

Name: MR. PIERRE DUVAL LAGUERRE
Title or Position: RN
Credential: REGISTERD NURSE
Phone: 305-807-2974