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General NPI Number Information
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NPI Number | 1417366253
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Entity Type | Organization
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Legal Business Name | STATUS MED ASSISTANCE, LLC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 17070 COLLINS AVE 257
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3635
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Country | US
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Telephone | 305-306-0000
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Fax | 305-306-1111
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Provider Business Mailing Address
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Address Line | 17070 COLLINS AVE 257
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3635
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Country | US
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Telephone | 305-306-0000
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Fax | 305-306-1111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIANA BUBUCEA
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Credential | MD
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Telephone | 305-306-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME113594
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License Number State | FL
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