MEDICARE: CORAL THERAPY & MEDICAL CENTER GROUP CORP

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
1	261Q00000X	Clinic/Center	MA69846

General Provider Information

NPI Number	:	1376965194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL THERAPY & MEDICAL CENTER GROUP CORP

Provider Business Mailing Address
First Line	:	4587 SW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4409
Country	:	US
Telephone Number	:	786-366-2745
Fax Number	:	305-328-8350

Provider Business Practice Location Address
First Line	:	4587 SW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4409
Country	:	US
Telephone Number	:	786-366-2745
Fax Number	:	305-328-8350

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSLAYNE TAPANES
Credential	:
Telephone Number	:	786-366-2745

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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