Provider Demographics
NPI:1376704775
Name:NEUROLOGY-NEUROSURGERY OF DADE AND BROWARD
Entity Type:Organization
Organization Name:NEUROLOGY-NEUROSURGERY OF DADE AND BROWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-394-8594
Mailing Address - Street 1:18520 NW 67TH AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3302
Mailing Address - Country:US
Mailing Address - Phone:305-557-6201
Mailing Address - Fax:305-557-6203
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:305-557-6201
Practice Address - Fax:305-557-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME89140207T00000X
FLME89140208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274781200Medicaid
FL274781200Medicaid