Provider Demographics
NPI:1861469702
Name:CMS MIAMI SOUTH
Entity Type:Organization
Organization Name:CMS MIAMI SOUTH
Other - Org Name:FLORIDA DEPARTMENT OF HEALTH CHILDRENS MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-349-1330
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:COTTAGE #5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:786-624-2490
Mailing Address - Fax:786-624-5790
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:COTTAGE #5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-2490
Practice Address - Fax:786-624-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare