=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053505073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | X-PRESS MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2007
-----------------------------------------------------
Last Update Date | 03/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 CORAL WAY SUITE #101
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-238-2170
-----------------------------------------------------
Fax | 305-444-7509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 CORAL WAY SUITE # 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-238-2170
-----------------------------------------------------
Fax | 305-444-7509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. MARITZA NOVAS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 305-562-1265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------