Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Oct 31, 2024
License(s)
11036247 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5114 SW 133RD COURT DR | Miami, FL 33175-5261 | 786-541-7043 |
| LOCATION | 14283 SW 42ND ST | Miami, FL 33175-6408 | 305-226-1001 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.