MEDICARE: EDUARDO EVORA BS

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366893273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO EVORA BS

Provider Business Mailing Address
First Line	:	13121 NW 7TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-2358
Country	:	US
Telephone Number	:	305-824-8787
Fax Number	:	305-824-8774

Provider Business Practice Location Address
First Line	:	4118 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4107
Country	:	US
Telephone Number	:	305-824-8787
Fax Number	:	305-824-8774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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