Healthcare Provider Details

I. General information

NPI: 1164203444
Provider Name (Legal Business Name): SPRINGS MEDICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 W FLAGLER ST STE 101
MIAMI FL
33135-2017
US

IV. Provider business mailing address

1778 W FLAGLER ST STE 101
MIAMI FL
33135-2017
US

V. Phone/Fax

Practice location:
  • Phone: 305-317-6091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: YADIRA MONTALVO
Title or Position: PRESIDENT
Credential:
Phone: 786-443-4361