| NPI | 1417108879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH FUENTES Billing/ Credentialing Clerk 305-412-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME 0064553) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2008-10-03 |