Provider Demographics
NPI:1811055536
Name:TAVERNIER NEUROLOGICAL CENTER, INC.
Entity type:Organization
Organization Name:TAVERNIER NEUROLOGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY - TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-853-0415
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-0460
Mailing Address - Country:US
Mailing Address - Phone:305-853-0415
Mailing Address - Fax:305-853-1708
Practice Address - Street 1:91550 OVERSEAS HWY
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 115
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2506
Practice Address - Country:US
Practice Address - Phone:305-853-0415
Practice Address - Fax:305-853-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 841152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263830400Medicaid
FL263830400Medicaid