1669795118 NPI number — ZYTRY MEDICAL SERVICES

Table of content: (NPI 1669795118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669795118 NPI number — ZYTRY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZYTRY MEDICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669795118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 NW 79TH AVE
Provider Second Line Business Mailing Address:
SUITE 518
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-6556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-722-8993
Provider Business Mailing Address Fax Number:
305-722-8992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 NW 79TH AVE
Provider Second Line Business Practice Location Address:
SUITE 518
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-722-8993
Provider Business Practice Location Address Fax Number:
305-722-8992
Provider Enumeration Date:
03/11/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSORIO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
305-722-8993

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  ME82265 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)