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General NPI Number Information
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NPI Number | 1578039764
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Entity Type | Organization
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Legal Business Name | MIAMI CHILDRENS HEALTH PLAN
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 5775 BLUE LAGOON DR STE 230
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City | MIAMI
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State | FL
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Zip | 33126-7012
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Country | US
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Telephone | 786-624-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 786-624-2668
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MR. JOSE CAMPS
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Credential |
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Telephone | 786-624-2668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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