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General NPI Number Information
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NPI Number | 1699384248
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Entity Type | Organization
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Legal Business Name | FIESTA ADULT CENTER LLC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 7816 NE 2ND AVE
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City | MIAMI
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State | FL
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Zip | 33138-4805
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Country | US
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Telephone | 786-326-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 18073 NW 74TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-8455
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Country | US
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Telephone | 786-326-6331
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MELISSA HEVIA
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Credential |
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Telephone | 786-204-2827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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