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General NPI Number Information
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NPI Number | 1538707252
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Entity Type | Organization
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Legal Business Name | INNER CITY DANCE CLUB OF MIAMI CORPORATION
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6161 NW 9TH AVE
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City | MIAMI
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State | FL
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Zip | 33127-1013
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Country | US
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Telephone | 305-726-5075
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 NW 84TH TER
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City | MIAMI
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State | FL
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Zip | 33147-4336
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Country | US
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Telephone | 305-726-5075
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LATRICE MONIQUE HILL
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Credential |
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Telephone | 305-726-5075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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