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General NPI Number Information
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NPI Number | 1679962740
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Entity Type | Organization
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Legal Business Name | JOSE S BASAGOITIA,M.D
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 3661 S MIAMI AVE SUITE# 705
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City | MIAMI
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State | FL
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Zip | 33133-4236
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Country | US
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Telephone | 305-854-0445
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Fax | 305-854-5099
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Provider Business Mailing Address
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Address Line | 3661 S MIAMI AVE SUITE# 705
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City | MIAMI
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State | FL
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Zip | 33133-4236
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Country | US
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Telephone | 305-854-0445
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Fax | 305-854-5099
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Authorized Official
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Title or Position | OWNER
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Name | JOSE SIMON BASAGOITIA
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Credential | MD
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Telephone | 305-854-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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