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General NPI Number Information
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NPI Number | 1922376201
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Entity Type | Organization
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Legal Business Name | NEOSTART CORP
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 900 W 49TH ST SUITE #430
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 305-819-1551
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Fax | 305-819-1159
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Provider Business Mailing Address
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Address Line | 900 W 49TH ST SUITE #430
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 305-819-1551
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Fax | 305-819-1159
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. MARIA XIMENA GRABER
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Credential | M.D
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Telephone | 305-819-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number | OS8448
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License Number State | FL
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