=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972687556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASTHMA & ALLERGY ASSOCIATES OF FL PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 12/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 SW 87TH AVE C-340
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-0109
-----------------------------------------------------
Fax | 305-595-7092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 SW 87TH AVE C-340
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-595-0109
-----------------------------------------------------
Fax | 305-595-2836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | PATRICIA MONTES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-595-0109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | ME0046002
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------