Healthcare Provider Details

I. General information

NPI: 1902992431
Provider Name (Legal Business Name): BMA CUTLER RIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18942 S DIXIE HWY
MIAMI FL
33157-7711
US

IV. Provider business mailing address

18942 S DIXIE HWY
MIAMI FL
33157-7711
US

V. Phone/Fax

Practice location:
  • Phone: 305-252-7575
  • Fax: 305-252-9539
Mailing address:
  • Phone: 305-252-7575
  • Fax: 305-252-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number389855-9
License Number StateFL

VIII. Authorized Official

Name: MRS. DARLENA M BANAS
Title or Position: CLINICAL MANAGER
Credential: RN
Phone: 305-252-7575