Healthcare Provider Details

I. General information

NPI: 1548219926
Provider Name (Legal Business Name): ORTHOPEDIC INNOVATORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SW 117TH AVE SUITE B-104
MIAMI FL
33186-2175
US

IV. Provider business mailing address

8900 SW 117TH AVE SUITE B-104
MIAMI FL
33186-2175
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-0159
  • Fax: 786-263-0179
Mailing address:
  • Phone: 305-279-0159
  • Fax: 786-263-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. VIRGILIA CORCES
Title or Position: PRESIDENT
Credential:
Phone: 305-279-0159