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General NPI Number Information
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NPI Number | 1043890221
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Entity Type | Organization
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Legal Business Name | ATLANTIC HEALTH MSO LLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 8785 SW 165TH AVE STE 200-2014
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City | MIAMI
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State | FL
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Zip | 33193-5826
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Country | US
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Telephone | 305-363-2886
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Fax |
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Provider Business Mailing Address
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Address Line | 8785 SW 165TH AVE STE 200-2014
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City | MIAMI
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State | FL
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Zip | 33193-5826
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Country | US
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Telephone | 305-363-2886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RENE DAVILA HASTINGS
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Credential |
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Telephone | 305-363-2886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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