MEDICARE: FENIX HEALTH CENTER 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
1	208D00000X	General Practice Physician

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

General Provider Information

NPI Number	:	1740949965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENIX HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	5901 NW 183RD ST STE 137
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6009
Country	:	US
Telephone Number	:	305-974-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 NW 183RD ST STE 137
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6009
Country	:	US
Telephone Number	:	305-974-4049
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DIANABEL BLANCO
Credential	:
Telephone Number	:	305-974-4049

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	05/16/2022

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Directions to “FENIX HEALTH CENTER INC ” Practice Location

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