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General NPI Number Information
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NPI Number | 1346440096
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Entity Type | Organization
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Legal Business Name | SAN MARTIN DE PORRAS ALF, INC.
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 1840 NW 15TH ST
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City | MIAMI
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State | FL
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Zip | 33125-2202
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Country | US
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Telephone | 305-305-9882
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Fax |
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Provider Business Mailing Address
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Address Line | 1840-42 NW 15 STREET
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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 | 305-305-9882
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MACARIO HUAITALLA
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Credential |
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Telephone | 305-305-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL9895
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License Number State | FL
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