Provider Demographics
NPI:1275874620
Name:RESOLUTION MEDICAL CENTER
Entity Type:Organization
Organization Name:RESOLUTION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALMYS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIESO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-355-1440
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD STE 2G4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 2G4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7012
Practice Address - Country:US
Practice Address - Phone:786-355-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62281320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities