=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861059966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDQUEST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2019
-----------------------------------------------------
Last Update Date | 05/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 S MIAMI AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-423-1516
-----------------------------------------------------
Fax | 786-219-2134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 S MIAMI AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-423-1516
-----------------------------------------------------
Fax | 786-219-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MBR
-----------------------------------------------------
Name | MRS. YVETTE ALMEIDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-905-9051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------