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General NPI Number Information
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NPI Number | 1679173926
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Entity Type | Organization
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Legal Business Name | HAVEN MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 12268 TAMIAMI TRL E STE 303
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City | NAPLES
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State | FL
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Zip | 34113-7946
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Country | US
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Telephone | 239-331-3276
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Fax |
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Provider Business Mailing Address
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Address Line | 12268 TAMIAMI TRL E STE 303
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City | NAPLES
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State | FL
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Zip | 34113-7946
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Country | US
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Telephone | 239-331-3276
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Fax | 239-331-3587
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARA SOTO
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Credential | LMT
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Telephone | 813-381-8975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | 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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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