Provider Demographics
NPI:1497230692
Name:MEDISTE CORP
Entity Type:Organization
Organization Name:MEDISTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-615-5650
Mailing Address - Street 1:7171 SW 24TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1693
Mailing Address - Country:US
Mailing Address - Phone:786-615-5650
Mailing Address - Fax:786-615-5642
Practice Address - Street 1:7171 SW 24TH ST STE 403
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1693
Practice Address - Country:US
Practice Address - Phone:786-615-5650
Practice Address - Fax:786-615-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy