Provider Demographics
NPI:1174712236
Name:PUBLIC HEALTH TRUST
Entity type:Organization
Organization Name:PUBLIC HEALTH TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIESTEBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-466-8475
Mailing Address - Street 1:3801 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-9800
Mailing Address - Country:US
Mailing Address - Phone:786-466-8475
Mailing Address - Fax:305-571-1904
Practice Address - Street 1:3801 BISCAYNE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-9800
Practice Address - Country:US
Practice Address - Phone:786-466-8475
Practice Address - Fax:305-571-1904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HEALTH TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology