Provider Demographics
NPI:1205846748
Name:AMERICAN TECHNICAL ACADEMY GROUP CORP
Entity Type:Organization
Organization Name:AMERICAN TECHNICAL ACADEMY GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-8888
Mailing Address - Street 1:7990 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6550
Mailing Address - Country:US
Mailing Address - Phone:305-266-8888
Mailing Address - Fax:305-267-8154
Practice Address - Street 1:7990 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6550
Practice Address - Country:US
Practice Address - Phone:305-266-8888
Practice Address - Fax:305-267-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN