MEDICARE: SNAP HUMAN ALIGNMENT OF MIAMI BEACH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse

General Provider Information

NPI Number	:	1073398871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNAP HUMAN ALIGNMENT OF MIAMI BEACH LLC

Provider Business Mailing Address
First Line	:	815 NW 57TH AVE STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2054
Country	:	US
Telephone Number	:	786-593-3622
Fax Number	:

Provider Business Practice Location Address
First Line	:	6879 COLLINS AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3243
Country	:	US
Telephone Number	:	305-331-6697
Fax Number	:	305-888-5299

Authorized Official
Title or Position	:	PURCHASER
Name	:	JOSE FERNANDEZ
Credential	:
Telephone Number	:	786-593-3622

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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