| NPI | 1154164457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANY NINO Director Network Operations 786-878-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |