Provider Demographics
NPI:1851974588
Name:7TH AVENUE MEDICAL PLAZA LLC
Entity Type:Organization
Organization Name:7TH AVENUE MEDICAL PLAZA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-670-4424
Mailing Address - Street 1:300 S PINE ISLAND RD STE 238
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2631
Mailing Address - Country:US
Mailing Address - Phone:542-365-5119
Mailing Address - Fax:
Practice Address - Street 1:10071 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-1348
Practice Address - Country:US
Practice Address - Phone:305-403-7777
Practice Address - Fax:305-403-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115317600Medicaid
FL117193800Medicaid
FL118969400Medicaid
FL002648900Medicaid