Healthcare Provider Details

I. General information

NPI: 1982026449
Provider Name (Legal Business Name): EDENS BAPTISTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 NE 167TH ST APT 200
NORTH MIAMI BEACH FL
33162-3713
US

IV. Provider business mailing address

999 NE 167TH ST APT 200
NORTH MIAMI BEACH FL
33162-3713
US

V. Phone/Fax

Practice location:
  • Phone: 786-286-3523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT 11194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: