Healthcare Provider Details

I. General information

NPI: 1184581548
Provider Name (Legal Business Name): INTERAMERICA RESTAURANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 NE 168TH ST
NORTH MIAMI BEACH FL
33162-3115
US

IV. Provider business mailing address

500 NW 36TH ST APT 1001
MIAMI FL
33127-3154
US

V. Phone/Fax

Practice location:
  • Phone: 305-772-5444
  • Fax:
Mailing address:
  • Phone: 786-492-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: CECILIA LOPEZ CEPERO
Title or Position: PRESIDENT
Credential:
Phone: 305-772-5444