Provider Demographics
NPI:1356757298
Name:FLORIDA INTERNATIONAL UNIVERSITY
Entity type:Organization
Organization Name:FLORIDA INTERNATIONAL UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. ASSOCIATE ATHLETIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-348-2352
Mailing Address - Street 1:1180 SW 113TH AVE
Mailing Address - Street 2:ARENA ROOM 156
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:1180 SW 113TH AVE
Practice Address - Street 2:ARENA ROOM 156
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:800-555-9073
Practice Address - Fax:972-367-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health