Provider Demographics
NPI:1790541902
Name:BIOVISION MEDICAL LLC
Entity Type:Organization
Organization Name:BIOVISION MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RUIZ BERGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-250-7400
Mailing Address - Street 1:13944 SW 8TH ST STE 216
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3008
Mailing Address - Country:US
Mailing Address - Phone:305-418-0600
Mailing Address - Fax:
Practice Address - Street 1:13944 SW 8TH ST STE 216
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3008
Practice Address - Country:US
Practice Address - Phone:305-418-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service