Provider Demographics
NPI:1891081188
Name:MIAMI RESCUE MISSION CLINIC INC
Entity type:Organization
Organization Name:MIAMI RESCUE MISSION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-572-2026
Mailing Address - Street 1:2015 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4901
Mailing Address - Country:US
Mailing Address - Phone:305-572-2026
Mailing Address - Fax:305-572-2025
Practice Address - Street 1:2015 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4901
Practice Address - Country:US
Practice Address - Phone:305-572-2026
Practice Address - Fax:305-572-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN298172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013928985OtherAPPLY FOR MEDICARE