Healthcare Provider Details

I. General information

NPI: 1821291188
Provider Name (Legal Business Name): INTERNAL MEDICINE, PRIMARY CARE ASSOCIATES OF SOUTH FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

IV. Provider business mailing address

301 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-0522
  • Fax: 305-653-1138
Mailing address:
  • Phone: 305-940-0522
  • Fax: 305-653-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME77891
License Number StateFL

VIII. Authorized Official

Name: DR. VICTOR I TAMAYO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-940-0522