Provider Demographics
NPI:1447519566
Name:AVENTURA GERIATRIC PROFESSIONAL SERVICES CORPORATION
Entity type:Organization
Organization Name:AVENTURA GERIATRIC PROFESSIONAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALCBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-343-2853
Mailing Address - Street 1:21200 NE 38TH AVE
Mailing Address - Street 2:SUITE 2902
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4060
Mailing Address - Country:US
Mailing Address - Phone:305-343-2853
Mailing Address - Fax:954-535-0000
Practice Address - Street 1:21200 NE 38TH AVE
Practice Address - Street 2:SUITE 2902
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4060
Practice Address - Country:US
Practice Address - Phone:305-343-2853
Practice Address - Fax:954-535-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty