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General NPI Number Information
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NPI Number | 1316225030
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Entity Type | Organization
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Legal Business Name | ENRIQUE HANABERGH JR., M.D., P.A.
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 21097 NE 27TH CT SUITE 210
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City | AVENTURA
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State | FL
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Zip | 33180-1204
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Country | US
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Telephone | 305-328-9557
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Fax | 855-760-7770
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Provider Business Mailing Address
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Address Line | 21097 NE 27TH CT SUITE 210
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City | AVENTURA
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State | FL
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Zip | 33180-1204
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Country | US
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Telephone | 305-328-9557
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Fax | 855-760-7770
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ENRIQUE HANABERGH JR.
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Credential | M.D.
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Telephone | 305-310-2799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME 104210
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License Number State | FL
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