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General NPI Number Information
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NPI Number | 1760739270
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Entity Type | Organization
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Legal Business Name | MIAMI GARDENS HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 13196 SW 50TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-5527
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Country | US
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Telephone | 305-333-3872
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Fax |
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Provider Business Mailing Address
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Address Line | 13196 SW 50TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-5527
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Country | US
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Telephone | 305-333-3872
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | MRS. BRENDA ANN PARKS
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Credential | ARNP
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Telephone | 305-333-3872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1952242
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License Number State | FL
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