=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588393060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEISU RESEARCH GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2022
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 NW 170TH ST STE 105
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-3475
-----------------------------------------------------
Fax | 305-974-5371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NW 170TH ST STE 105
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-705-3475
-----------------------------------------------------
Fax | 305-974-5371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SABRINA MICHELLE CUESTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-705-3475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1100X
-----------------------------------------------------
Taxonomy Name | Research Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------