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General NPI Number Information
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NPI Number | 1750730867
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Entity Type | Organization
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Legal Business Name | NACIDOS EN DIVINA MICEROCORDIA INC
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 315 S US HIGHWAY 41
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City | RUSKIN
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State | FL
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Zip | 33570-4660
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Country | US
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Telephone | 813-662-4808
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Fax |
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Provider Business Mailing Address
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Address Line | 315 US HIGHWAY SOUTH 41
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City | RUSKIN
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State | FL
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Zip | 33570
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Country | US
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Telephone | 813-662-4808
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Fax | 813-649-8323
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Authorized Official
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Title or Position | CHEIF OF OPERATION
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Name | MRS. JENNY I TORRES
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Credential |
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Telephone | 813-662-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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