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General NPI Number Information
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NPI Number | 1063769412
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Entity Type | Organization
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Legal Business Name | NANGI SHORES MEDICAL GROUP
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Dates
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Enumeration Date | 08/04/2012
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Last Update Date | 08/04/2012
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Provider Practice Location Address
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Address Line | 9999 NE 2ND AVE STE 214
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2345
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Country | US
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Telephone | 305-384-8789
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Fax | 786-953-4169
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Provider Business Mailing Address
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Address Line | 9999 NE 2ND AVE STE 214
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2345
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Country | US
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Telephone | 305-384-8789
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Fax | 786-953-4169
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALPHONSE G DUFRENY
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Credential | M.D.
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Telephone | 305-756-9392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | ME85072
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License Number State | FL
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