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General NPI Number Information
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NPI Number | 1154703734
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Entity Type | Organization
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Legal Business Name | MIAMI MEDICAL & REJUVENATION INC
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 1470 NW 107 AVE SUITE G
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City | MIAMI
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State | FL
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Zip | 33172-2734
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Country | US
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Telephone | 305-594-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 NW 107 AVE SUITE G
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City | MIAMI
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State | FL
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Zip | 33172-2734
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Country | US
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Telephone | 305-594-8666
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CESAR BERTOLOTTI
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Credential | MD
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Telephone | 305-594-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 117031
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License Number State | FL
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