Provider Demographics
NPI:1275106049
Name:AGAPE HEALTH PROVIDER LLC
Entity Type:Organization
Organization Name:AGAPE HEALTH PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALENZUELA JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-434-0526
Mailing Address - Street 1:7171 CORAL WAY STE 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1693
Mailing Address - Country:US
Mailing Address - Phone:305-434-0526
Mailing Address - Fax:
Practice Address - Street 1:7171 CORAL WAY STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1693
Practice Address - Country:US
Practice Address - Phone:305-434-0526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty