Healthcare Provider Details

I. General information

NPI: 1821561010
Provider Name (Legal Business Name): AMAVITA CARE CONTINUUM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 305
N MIAMI BEACH FL
33169-5511
US

IV. Provider business mailing address

100 NW 170TH ST STE 305
N MIAMI BEACH FL
33169-5511
US

V. Phone/Fax

Practice location:
  • Phone: 305-249-5666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEDRO O MARTINEZ-CLARK
Title or Position: MD
Credential:
Phone: 305-249-5666