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General NPI Number Information
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NPI Number | 1447712112
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Entity Type | Organization
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Legal Business Name | BLACK CORAL GALLERY INC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 19675 SW 264 ST
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City | HOMESTEAD
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State | FL
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Zip | 33031
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Country | US
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Telephone | 813-451-4417
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Fax | 305-386-8357
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Provider Business Mailing Address
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Address Line | 16267 SW 88TH ST
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City | MIAMI
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State | FL
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Zip | 33196
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Country | US
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Telephone | 305-386-8356
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Fax | 305-386-8357
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA GRANDA
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Credential |
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Telephone | 305-386-8356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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