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NPI Code Detail

MEDICARE: ERTAMAYO INC

MEDICARE: ERTAMAYO INC
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
1207R00000XInternal Medicine PhysicianME67715FL

General Provider Information

NPI Number : 1528489200
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERTAMAYO INC
Provider Business Mailing Address
First Line : 9037 BISCAYNE BLVD
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33138-3221
Country : US
Telephone Number : 305-835-2797
Fax Number :
Provider Business Practice Location Address
First Line : 9037 BISCAYNE BLVD
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33138-3221
Country : US
Telephone Number : 305-835-2797
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : OMARA TAMAYO
Credential :
Telephone Number : 305-835-2797
Provider Enumeration Date : 12/23/2013
Last Update Date : 12/30/2013

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Directions to “ERTAMAYO INC ” Practice Location

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