Provider Demographics
NPI:1275961872
Name:BANYAN HEALTH SYSTEMS
Entity Type:Organization
Organization Name:BANYAN HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW
Authorized Official - Phone:305-781-7265
Mailing Address - Street 1:310 FONTAINEBLEAU BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5726
Mailing Address - Country:US
Mailing Address - Phone:305-781-7265
Mailing Address - Fax:
Practice Address - Street 1:11031 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7182
Practice Address - Country:US
Practice Address - Phone:786-293-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation