Basic Information
| Provider Information | |||||||||
| NPI: | 1265562367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI VA HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12055 PINE NEEDLE LN | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331565720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056653109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
| FaxNumber: | 3055753222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
| AuthorizedOfficialMiddleName: | ROJAS | ||||||||
| AuthorizedOfficialTitleorPosition: | ANATOMIC PATHOLOGY SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3053244455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | SU34793 | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.