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General NPI Number Information
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NPI Number | 1821438953
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Entity Type | Organization
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Legal Business Name | KRYSTAL BITTAR LLC
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 2622 SW 32ND CT
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City | MIAMI
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State | FL
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Zip | 33133-2804
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Country | US
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Telephone | 305-951-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 SW 32ND CT
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City | MIAMI
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State | FL
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Zip | 33133-2804
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Country | US
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Telephone | 305-951-1116
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KRYSTAL BITTAR
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Credential | PSY.D.
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Telephone | 305-919-8099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PY8352
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License Number State | FL
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