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General NPI Number Information
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NPI Number | 1396420782
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Entity Type | Organization
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Legal Business Name | MIAMI VIP MEDICAL CORP
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 4355 W 16TH AVE STE 205B
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City | HIALEAH
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State | FL
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Zip | 33012-7668
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Country | US
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Telephone | 786-953-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 4355 W 16TH AVE STE 205B
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City | HIALEAH
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State | FL
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Zip | 33012-7668
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AIDENI GONZALEZ
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Credential |
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Telephone | 305-587-4889
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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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