=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013303072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN PHYSICIANS AT HOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2015
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12550 BISCAYNE BLVD SUITE 205
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-9389
-----------------------------------------------------
Fax | 888-680-3165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12550 BISCAYNE BLVD SUITE 205
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-9389
-----------------------------------------------------
Fax | 888-680-3165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALAIN HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-456-9389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 9582
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------