Provider Demographics
NPI:1336504307
Name:EMINENCE MEDICAL & CLINICAL RESEARCH INC
Entity Type:Organization
Organization Name:EMINENCE MEDICAL & CLINICAL RESEARCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-810-2119
Mailing Address - Street 1:1419 W WATERS AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2895
Mailing Address - Country:US
Mailing Address - Phone:813-810-2119
Mailing Address - Fax:
Practice Address - Street 1:1419 W WATERS AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2895
Practice Address - Country:US
Practice Address - Phone:813-810-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty