=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477805455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBC MEDICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2012
-----------------------------------------------------
Last Update Date | 10/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18901 SW 106TH AVE STE 224
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-7665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-522-1848
-----------------------------------------------------
Fax | 786-565-4587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18901 SW 106TH AVE STE 224
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-7665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-522-1848
-----------------------------------------------------
Fax | 786-565-4587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEJANDRO ALBERTO CACERES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-691-8429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174V00000X
-----------------------------------------------------
Taxonomy Name | Clinical Ethicist
-----------------------------------------------------
License Number | MM 29080
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------