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General NPI Number Information
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NPI Number | 1861469702
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Entity Type | Organization
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Legal Business Name | CMS MIAMI SOUTH
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE COTTAGE #5
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 786-624-2490
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Fax | 786-624-5790
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Provider Business Mailing Address
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Address Line | 3100 SW 62ND AVE COTTAGE #5
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 786-624-2490
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Fax | 786-624-5790
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MRS. CARMEN LOPEZ
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Credential |
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Telephone | 305-349-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | FL
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