Healthcare Provider Details

I. General information

NPI: 1285340083
Provider Name (Legal Business Name): MIAMI BEACH MEDICAL CONSULTANTS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 PALM RIVER RD
TAMPA FL
33619-4128
US

IV. Provider business mailing address

1400 NW 107TH AVE STE 500
SWEETWATER FL
33172-2746
US

V. Phone/Fax

Practice location:
  • Phone: 813-392-1894
  • Fax:
Mailing address:
  • Phone: 305-534-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSE D SUAREZ
Title or Position: COM
Credential:
Phone: 305-534-0076