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General NPI Number Information
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NPI Number | 1366147423
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Entity Type | Organization
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Legal Business Name | AVANT GARDE MANAGEMENT ASSOCIATES
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 25865 SW 139TH PATH
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City | HOMESTEAD
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State | FL
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Zip | 33032-6696
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Country | US
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Telephone | 786-426-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 25865 SW 139TH PATH
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City | HOMESTEAD
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State | FL
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Zip | 33032-6696
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Country | US
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Telephone | 786-426-2868
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAIN TEJEDA JR.
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Credential |
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Telephone | 786-426-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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