Provider Demographics
NPI:1154703734
Name:MIAMI MEDICAL & REJUVENATION INC
Entity type:Organization
Organization Name:MIAMI MEDICAL & REJUVENATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-594-8666
Mailing Address - Street 1:1470 NW 107 AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2734
Mailing Address - Country:US
Mailing Address - Phone:305-594-8666
Mailing Address - Fax:
Practice Address - Street 1:1470 NW 107 AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2734
Practice Address - Country:US
Practice Address - Phone:305-594-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 117031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty