Provider Demographics
NPI:1750334215
Name:MEDITERRANEO THERAPY, INC.
Entity type:Organization
Organization Name:MEDITERRANEO THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GISELA
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-485-9578
Mailing Address - Street 1:9600 SW 8TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2900
Mailing Address - Country:US
Mailing Address - Phone:305-485-9578
Mailing Address - Fax:305-485-9579
Practice Address - Street 1:9600 SW 8TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2900
Practice Address - Country:US
Practice Address - Phone:305-485-9578
Practice Address - Fax:305-485-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686833Medicare Oscar/Certification