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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (LA) PC

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (LA) PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2208D00000XGeneral Practice Physician
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1235752692
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE (LA) PC
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 4700 MILLENIA LAKES BLVD.
Second Line :
City : ORLANDO
State : FL
Zip : 32839-7823
Country : US
Telephone Number : 407-447-7120
Fax Number : 407-770-0661
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 05/20/2020
Last Update Date : 08/22/2024

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Directions to “CENTERWELL SENIOR PRIMARY CARE (LA) PC ” Practice Location

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