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General NPI Number Information
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NPI Number | 1336762327
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Entity Type | Organization
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Legal Business Name | EVIVIA
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 09/06/2021
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Provider Practice Location Address
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Address Line | 1370 WASHINGTON AVE STE 224
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City | MIAMI BEACH
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State | FL
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Zip | 33139-4215
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Country | US
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Telephone | 786-673-4029
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 WASHINGTON AVE STE 224
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City | MIAMI BEACH
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State | FL
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Zip | 33139-4215
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Country | US
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Telephone | 786-673-4029
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANTONINA EREMENKO
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Credential | NP-C
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Telephone | 786-673-4029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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