=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336903921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MDHELPS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2024
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 SW 75TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-1541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 SW 90TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-1541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EMILIO LUIS GONZALEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-351-1541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------