Provider Demographics
NPI:1386802262
Name:HEAVEN MEDICAL GROUP CORP
Entity type:Organization
Organization Name:HEAVEN MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:DE F
Authorized Official - Last Name:PI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-260-0886
Mailing Address - Street 1:7171 CORAL WAY STE 316
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1692
Mailing Address - Country:US
Mailing Address - Phone:305-260-0886
Mailing Address - Fax:305-677-2043
Practice Address - Street 1:7171 CORAL WAY STE 316
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1692
Practice Address - Country:US
Practice Address - Phone:305-260-0886
Practice Address - Fax:305-677-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service