=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245520956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSMERIS CHAVIANO BS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 04/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8100 OAK LN STE 404
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-5876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-952-3125
-----------------------------------------------------
Fax | 305-406-9478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11031 NE 6TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-7182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-398-6100
-----------------------------------------------------
Fax | 305-757-4465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------