Provider Demographics
NPI:1346977600
Name:MIAMI GARDENS ORTHOPEDICS AND PAIN MANAGEMENT
Entity Type:Organization
Organization Name:MIAMI GARDENS ORTHOPEDICS AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-303-9154
Mailing Address - Street 1:4888 NW 183RD ST STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2940
Mailing Address - Country:US
Mailing Address - Phone:305-317-3990
Mailing Address - Fax:305-549-5314
Practice Address - Street 1:4888 NW 183RD ST STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2940
Practice Address - Country:US
Practice Address - Phone:305-317-3990
Practice Address - Fax:305-549-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center