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General NPI Number Information
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NPI Number | 1154003457
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Entity Type | Organization
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Legal Business Name | MIA33AH01 LLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 1190 NW 95TH ST STE 303
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City | MIAMI
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State | FL
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Zip | 33150-2066
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Country | US
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Telephone | 789-360-3492
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 NW 95TH ST STE 303
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City | MIAMI
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State | FL
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Zip | 33150-2066
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Country | US
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Telephone | 789-360-3492
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DR. JASON MARUCCI
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Credential | DC
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Telephone | 561-222-8208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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