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General NPI Number Information
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NPI Number | 1275961872
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Entity Type | Organization
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Legal Business Name | BANYAN HEALTH SYSTEMS
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 11031 NE 6TH AVE
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City | MIAMI
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State | FL
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Zip | 33161-7182
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Country | US
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Telephone | 786-293-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 310 FONTAINEBLEAU BLVD APT 505
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City | MIAMI
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State | FL
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Zip | 33172-5726
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Country | US
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Telephone | 305-781-7265
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. ALEJANDRO JAVIER LOPEZ JR.
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Credential | M.S.W.
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Telephone | 305-781-7265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | FL
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