1982951620 NPI number — CLINICAL THERAPY OF MIAMI, INC

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 1982951620 NPI number — CLINICAL THERAPY OF MIAMI, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL THERAPY OF MIAMI, INC
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:
1982951620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2012
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:
STE 729
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:
305-593-5121
Provider Business Mailing Address Fax Number:
305-593-5488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 NW 79TH AVE
Provider Second Line Business Practice Location Address:
STE 729
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:
305-593-5121
Provider Business Practice Location Address Fax Number:
305-593-5488
Provider Enumeration Date:
08/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-593-5121

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  AHCA HCC10086 , 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)





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