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General NPI Number Information
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NPI Number | 1700899333
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Entity Type | Organization
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Legal Business Name | KNIGHT STAR INC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 16782 NW 67TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-4202
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Country | US
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Telephone | 305-817-4392
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Fax | 305-817-4392
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Provider Business Mailing Address
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Address Line | 16782 NW 67TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-4202
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Country | US
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Telephone | 305-817-4392
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Fax | 305-817-4396
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAILEN BENGOCHEA
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Credential |
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Telephone | 305-817-4392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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