Healthcare Provider Details

I. General information

NPI: 1659582716
Provider Name (Legal Business Name): BARBARA DESAMOURS BLOT LM CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 NE 8TH AVE
NORTH MIAMI BEACH FL
33162-3618
US

IV. Provider business mailing address

16600 NE 8TH AVE
NORTH MIAMI BEACH FL
33162-3618
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-7080
  • Fax: 866-296-1719
Mailing address:
  • Phone: 786-399-7080
  • Fax: 866-296-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW158
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9327259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: