MEDICARE: UNIQUE PROFESSIONAL SERVICE, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902198179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUE PROFESSIONAL SERVICE, INC.

Provider Business Mailing Address
First Line	:	2344 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3249
Country	:	US
Telephone Number	:	305-649-6090
Fax Number	:	305-649-4576

Provider Business Practice Location Address
First Line	:	2344 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3249
Country	:	US
Telephone Number	:	305-649-6090
Fax Number	:	305-649-4576

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRISELL HERNANDEZ
Credential	:
Telephone Number	:	305-649-6090

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	05/09/2011

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