Basic Information
| Provider Information | |||||||||
| NPI: | 1891169116 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIAMI BLUE HEALTH CORP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 W 20TH AVE STE 501 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058213999 | ||||||||
| FaxNumber: | 3058213666 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 W 20TH AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058213999 | ||||||||
| FaxNumber: | 3058213666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2015 | ||||||||
| LastUpdateDate: | 11/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | ESCOBAR | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3058213999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.