Provider Demographics
NPI:1164796660
Name:MIAMI BEACH ELITE DIALYSIS
Entity Type:Organization
Organization Name:MIAMI BEACH ELITE DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-216-5048
Mailing Address - Street 1:714 W 51ST ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2615
Mailing Address - Country:US
Mailing Address - Phone:305-865-3751
Mailing Address - Fax:305-864-6157
Practice Address - Street 1:714 W 51ST ST STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2615
Practice Address - Country:US
Practice Address - Phone:305-865-3751
Practice Address - Fax:305-864-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment