| NPI | 1164203444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YADIRA MONTALVO President 786-443-4361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-11 |