=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336519966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFIRA HEALTH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2015
-----------------------------------------------------
Last Update Date | 09/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 US HIGHWAY 27
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34714-8908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-666-0828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1142 WILDE DR
-----------------------------------------------------
City | CELEBRATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34747-4046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-922-5870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ERICA NICOLE NIEVES
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 407-922-5870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | OPC5087
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------