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General NPI Number Information
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NPI Number | 1346977600
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Entity Type | Organization
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Legal Business Name | MIAMI GARDENS ORTHOPEDICS AND PAIN MANAGEMENT
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 4888 NW 183RD ST STE 113
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-2940
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Country | US
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Telephone | 305-317-3990
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Fax | 305-549-5314
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Provider Business Mailing Address
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Address Line | 4888 NW 183RD ST STE 113
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-2940
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Country | US
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Telephone | 305-317-3990
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Fax | 305-549-5314
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Authorized Official
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Title or Position | OWNER
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Name | MARICELA NICOLAS
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Credential |
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Telephone | 305-303-9154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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