Provider Demographics
NPI: | 1457006926 |
---|---|
Name: | PONSOL WEST MIAMI, LLC |
Entity Type: | Organization |
Organization Name: | PONSOL WEST MIAMI, LLC |
Other - Org Name: | PONSOL HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | FERNANDO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ESPINOSA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-208-0215 |
Mailing Address - Street 1: | 7801 SW 125TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PINECREST |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33156-6058 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9894 SW 40TH ST |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33165-3912 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-564-9471 |
Practice Address - Fax: | 305-564-9472 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-02-14 |
Last Update Date: | 2023-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |