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General NPI Number Information
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NPI Number | 1659990364
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Entity Type | Organization
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Legal Business Name | PROVECTUS HEALTH LLC
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 7887 N KENDALL DR STE 215
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City | MIAMI
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State | FL
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Zip | 33156-7758
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Country | US
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Telephone | 786-422-5223
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 S DIXIE HWY STE 1080
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City | CORAL GABLES
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State | FL
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Zip | 33146-3176
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Country | US
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Telephone | 786-422-5223
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ALDO GONZALEZ-BEICOS
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Credential | MD
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Telephone | 786-422-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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