Provider Demographics
NPI:1932847399
Name:ICONIC HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ICONIC HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-307-1876
Mailing Address - Street 1:8370 W FLAGLER ST STE 242
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2040
Mailing Address - Country:US
Mailing Address - Phone:786-307-1876
Mailing Address - Fax:786-744-7937
Practice Address - Street 1:8370 W FLAGLER ST STE 242
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2040
Practice Address - Country:US
Practice Address - Phone:786-321-1600
Practice Address - Fax:786-744-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service