Provider Demographics
NPI:1720171895
Name:FLORIDA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:MIAMI DADE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE ADMINISTRATOR I
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-845-0164
Mailing Address - Street 1:8175 NW 12TH ST
Mailing Address - Street 2:MICC BLDG SUITE 306 MIAMI DADE COUNTY HEALTH DEPARTMENT
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:MICC BLDG SUITE 306 MIAMI DADE COUNTY HEALTH DEPARTMENT
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0164
Practice Address - Fax:305-470-5846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027923400Medicaid
FL027923430Medicaid
FL027923400Medicaid
FL09102Medicare UPIN
FL027923409Medicaid