MEDICARE: MIA33AH01 LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084N0400X	Neurology Physician
2	111N00000X	Chiropractor
3	207XS0117X	Orthopaedic Surgery of the Spine Physician
4	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1154003457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIA33AH01 LLC

Provider Business Mailing Address
First Line	:	1190 NW 95TH ST STE 303
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-2066
Country	:	US
Telephone Number	:	789-360-3492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 NW 95TH ST STE 303
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-2066
Country	:	US
Telephone Number	:	789-360-3492
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	DR. JASON MARUCCI
Credential	:	DC
Telephone Number	:	561-222-8208

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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Directions to “MIA33AH01 LLC ” Practice Location

Language	Start Address	Practice Location

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