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General NPI Number Information
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NPI Number | 1295189140
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Entity Type | Organization
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Legal Business Name | TITE FAMILY PRACTICE AND SKIN CARE CLINIC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 2441 NW 7 ST
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City | MIAMI
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State | FL
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Zip | 33125
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Country | US
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Telephone | 305-501-2804
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Fax | 786-590-1080
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Provider Business Mailing Address
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Address Line | 2441 NW 7 ST
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City | MIAMI
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State | FL
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Zip | 33125
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Country | US
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Telephone | 305-501-2804
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Fax | 786-590-1080
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOEL ENRIQUEZ
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Credential | ARNP
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Telephone | 305-501-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | ARNP9227025
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License Number State | FL
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