Healthcare Provider Details

I. General information

NPI: 1467769059
Provider Name (Legal Business Name): HEALTHACCESS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 CORAL WAY SUITE 103
MIAMI FL
33155-6539
US

IV. Provider business mailing address

7805 CORAL WAY SUITE 103
MIAMI FL
33155-6539
US

V. Phone/Fax

Practice location:
  • Phone: 305-398-0807
  • Fax: 305-269-8825
Mailing address:
  • Phone: 305-398-0807
  • Fax: 305-269-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO L REGALADO
Title or Position: OWNER
Credential:
Phone: 305-398-0807