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General NPI Number Information
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NPI Number | 1891081188
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Entity Type | Organization
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Legal Business Name | MIAMI RESCUE MISSION CLINIC INC
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 2015 NW 1ST AVE
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City | MIAMI
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State | FL
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Zip | 33127-4901
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Country | US
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Telephone | 305-572-2026
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Fax | 305-572-2025
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Provider Business Mailing Address
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Address Line | 2015 NW 1ST AVE
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City | MIAMI
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State | FL
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Zip | 33127-4901
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Country | US
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Telephone | 305-572-2026
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Fax | 305-572-2025
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETE ALFREDO GUTIERREZ
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Credential | MD
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Telephone | 305-572-2026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | ACN298
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License Number State | FL
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