1164295721 NPI number — SOLVIVE OUTPATIENT SERVICES 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 1164295721 NPI number — SOLVIVE OUTPATIENT SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLVIVE OUTPATIENT SERVICES 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:
1164295721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 NE 191ST ST STE 8572
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:
33179-3899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-902-8274
Provider Business Mailing Address Fax Number:
949-695-4959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 NE 191ST ST STE 8572
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:
33179-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-902-8274
Provider Business Practice Location Address Fax Number:
949-695-4959
Provider Enumeration Date:
11/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BUITRAGO
Authorized Official First Name:
CAROLINA
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBR
Authorized Official Telephone Number:
305-904-4495

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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