Provider Demographics
NPI:1477618387
Name:DEPARTMENT OF VA, MIAMI VA HEALTH CARE
Entity Type:Organization
Organization Name:DEPARTMENT OF VA, MIAMI VA HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:DUVAL
Authorized Official - Last Name:LAGUERRE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERD NURSE
Authorized Official - Phone:305-807-2974
Mailing Address - Street 1:12530 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4551
Mailing Address - Country:US
Mailing Address - Phone:305-807-2974
Mailing Address - Fax:
Practice Address - Street 1:12530 NE 1ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-807-2974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235377282NC0060X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Not Answered283X00000XHospitalsRehabilitation Hospital