=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811775745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B&H MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2023
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 PONCE DE LEON BLVD STE 409
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-808-6130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 HARBOR DR
-----------------------------------------------------
City | KEY BISCAYNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33149-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-5585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. EVA DIAZ
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 305-431-4703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------