=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417288200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPREME TOUCH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2010
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13899 BISCAYNE BLVD SUITE 201
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-341-3518
-----------------------------------------------------
Fax | 305-341-3517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13899 BISCAYNE BLVD SUITE 201
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-341-3518
-----------------------------------------------------
Fax | 305-341-3517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | VILMA BARRAMEDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-290-3012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | MA 41724
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------