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General NPI Number Information
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NPI Number | 1801685672
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Entity Type | Organization
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Legal Business Name | WHITE COAT RESTORE & REVIVE LLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 7916 NW 162ND ST
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6111
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Country | US
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Telephone | 305-608-7401
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Fax | 279-300-3517
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Provider Business Mailing Address
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Address Line | 7916 NW 162ND ST
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6111
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Country | US
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Telephone | 305-608-7401
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. YANETSY OLIVERA ARENCIBIA
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Credential | MD
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Telephone | 305-608-7401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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