Provider Demographics
NPI:1194109447
Name:BUENA AVENTURA MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:BUENA AVENTURA MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-520-3382
Mailing Address - Street 1:20818 W. DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1147
Mailing Address - Country:US
Mailing Address - Phone:786-520-3382
Mailing Address - Fax:786-513-2203
Practice Address - Street 1:20818 W. DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33180-1147
Practice Address - Country:US
Practice Address - Phone:786-520-3382
Practice Address - Fax:786-513-2203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENA AVENTURA MEDICAL GROUP, LI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty