Healthcare Provider Details

I. General information

NPI: 1831897149
Provider Name (Legal Business Name): MD BILLING BOUTIQUE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18501 PINES BLVD STE 207B
PEMBROKE PINES FL
33029-1420
US

IV. Provider business mailing address

18501 PINES BLVD STE 207B
PEMBROKE PINES FL
33029-1420
US

V. Phone/Fax

Practice location:
  • Phone: 754-201-1202
  • Fax: 786-524-0880
Mailing address:
  • Phone: 754-201-1202
  • Fax: 786-524-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTINA CADAVIECO
Title or Position: PRESIDENT
Credential:
Phone: 754-244-9889