=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457903049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAM QUALITY SERVICES, CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2019
-----------------------------------------------------
Last Update Date | 07/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6611 FALCONSGATE AVE
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-260-1021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6611 FALCONSGATE AVE
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-260-1021
-----------------------------------------------------
Fax | 305-402-0941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MILADY GOMEZ
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 786-260-1021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------