Icom Hialeah LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ICOM HIALEAH LLC

Practice address

6600 W 12TH Ave
Hialeah, FL 33012-6450

Phone

(305) 846-7987

Fax

(786) 221-4442

NPI assigned

Jan 3, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tatiana Santiago Herzog

Title

Dentist

Phone

(305) 409-5392

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1376313130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 NE 13TH ST",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333041109",
            "telephone_number": "305-846-7987",
            "fax_number": "786-221-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 W 12TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330126450",
            "telephone_number": "305-846-7987",
            "fax_number": "786-221-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICOM HIALEAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO HERZOG",
        "authorized_official_first_name": "TATIANA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "305-409-5392"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.