=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982998597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICA VENAMER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 06/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10200 NW 25TH ST UNIT 114
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-482-9556
-----------------------------------------------------
Fax | 305-482-9557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10200 NW 25TH ST UNIT 114
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-482-9556
-----------------------------------------------------
Fax | 305-482-9557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | GIANPAOLO BELMONTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-482-9556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | HCC9551
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | HCC9153
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------