=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215490503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELIZE MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2019
-----------------------------------------------------
Last Update Date | 04/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5791 ST. THOMAS ST.
-----------------------------------------------------
City | BELIZE CITY
-----------------------------------------------------
State | BELIZE
-----------------------------------------------------
Zip | 99999
-----------------------------------------------------
Country | BZ
-----------------------------------------------------
Telephone | 501-223-0302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 39192
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33339-9192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TAMARA VAZQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-526-9751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------