1265614713 NPI number — AGUIRRE INTERNAL MEDICINE GROUP OF THE PALM BEACHES, LLC

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 1265614713 NPI number — AGUIRRE INTERNAL MEDICINE GROUP OF THE PALM BEACHES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGUIRRE INTERNAL MEDICINE GROUP OF THE PALM BEACHES, LLC
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:
1265614713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 SW 72ND AVE
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-5544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-662-5200
Provider Business Mailing Address Fax Number:
305-284-7948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6215 S DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33405-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-582-1201
Provider Business Practice Location Address Fax Number:
561-582-8076
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPO
Authorized Official First Name:
OTTO
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
305-662-5200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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