Provider Demographics
NPI:1033409008
Name:MIAMI QUALITY SERVICE
Entity Type:Organization
Organization Name:MIAMI QUALITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA COTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-884-8035
Mailing Address - Street 1:4471 NW 36TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7288
Mailing Address - Country:US
Mailing Address - Phone:305-884-8035
Mailing Address - Fax:305-884-8036
Practice Address - Street 1:4471 NW 36TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7288
Practice Address - Country:US
Practice Address - Phone:305-884-8035
Practice Address - Fax:305-884-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8185208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty