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General NPI Number Information
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NPI Number | 1184184673
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Entity Type | Organization
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Legal Business Name | MIAVIP MEDICAL STAFFING,LLC
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 7600 SW 87TH AVE
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City | MIAMI
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State | FL
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Zip | 33173-3601
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Country | US
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Telephone | 954-800-7350
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Fax | 954-827-0852
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Provider Business Mailing Address
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Address Line | 5944 CORAL RIDGE DR # 170
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3300
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Country | US
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Telephone | 954-800-7350
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Fax | 954-827-0852
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN BARACK
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Credential | MD
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Telephone | 954-800-7350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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