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General NPI Number Information
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NPI Number | 1891587986
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Entity Type | Organization
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Legal Business Name | CENTERS OF MEDICAL EXCELLENCE, LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 941 N. KROME AVENUE
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City | HOMESTEAD
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State | FL
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Zip | 33030-4408
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Country | US
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Telephone | 786-886-1030
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Fax | 786-377-9629
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Provider Business Mailing Address
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Address Line | 7925 NW 12 STREET, SUITE 201
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City | DORAL
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State | FL
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Zip | 33126-1821
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Country | US
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Telephone | 305-874-3909
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Fax | 305-874-3916
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Authorized Official
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Title or Position | COO.
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Name | SADITA BUSTAMANTE
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Credential |
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Telephone | 305-874-3909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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