1255785986 NPI number — CESAR HOED DE BECHE DC PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255785986 NPI number — CESAR HOED DE BECHE DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CESAR HOED DE BECHE DC PA
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:
1255785986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 S DOUGLAS RD
Provider Second Line Business Mailing Address:
SUITE 1008
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-6127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-227-4264
Provider Business Mailing Address Fax Number:
786-456-1505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 SW 152ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-227-4264
Provider Business Practice Location Address Fax Number:
786-456-1505
Provider Enumeration Date:
04/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOED DE BECHE
Authorized Official First Name:
CESAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-227-4264

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH11804 , 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)

  • Identifier: 114498700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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