1629430756 NPI number — PEDRO SEVILLA 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 1629430756 NPI number — PEDRO SEVILLA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDRO SEVILLA 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:
MIAMI PULMONARY SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1629430756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 562435
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33256-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-299-5419
Provider Business Mailing Address Fax Number:
844-431-6801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 SW 97TH AVE STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-299-5419
Provider Business Practice Location Address Fax Number:
844-431-6801
Provider Enumeration Date:
03/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SEVILLA SAEZ-BENITO
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-299-5419

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , 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: R9V8A . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 103236000 . 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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