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5080 Nw 74th Ave Miami FL 33166-5554 | |
| (305) 609-3300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5080 Nw 74th Ave, Miami, Florida |
| Authorized Official Name and Position | Eneida Reyes Figueredo (MGR) |
| Authorized Official Contact | 7862337050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5080 Nw 74th Ave Miami FL 33166-5554 Ph: (305) 609-3300 | 5080 Nw 74th Ave Miami FL 33166-5554 Ph: (305) 609-3300 |
| NPI Number | 1538936372 |
|---|---|
| Provider Enumeration Date | 12/11/2023 |
| Last Update Date | 02/06/2025 |
| Medicare PECOS PAC ID | 5193256055 |
|---|---|
| Medicare Enrollment ID | O20241002002075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538936372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
| Provider Name | Mariuska Aristica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295328615 PECOS PAC ID: 2567848633 Enrollment ID: I20220928000644 |
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