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General NPI Number Information
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NPI Number | 1154994929
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Entity Type | Organization
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Legal Business Name | ANGEL CMH CORP
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 17325 NW 27TH AVE # 206-207
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-4056
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Country | US
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Telephone | 786-822-7270
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Fax | 786-822-7271
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Provider Business Mailing Address
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Address Line | 17325 NW 27TH AVE # 206-207
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-4056
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Country | US
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Telephone | 786-822-7270
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Fax | 786-822-7271
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE VIERA
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Credential |
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Telephone | 786-822-7270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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