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General NPI Number Information
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NPI Number | 1457920308
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Entity Type | Organization
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Legal Business Name | PERIDOT MEDICAL GROUP
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 7374 SW 93RD AVE STE 202B
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City | MIAMI
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State | FL
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Zip | 33173-3246
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Country | US
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Telephone | 305-551-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 7374 SW 93RD AVE STE 202B
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City | MIAMI
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State | FL
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Zip | 33173-3246
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Country | US
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Telephone | 305-551-0900
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAMON LEON
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Credential | MD
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Telephone | 305-712-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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