MEDICARE: CORONADO MAXIMO HEALTH CARE INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417521311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORONADO MAXIMO HEALTH CARE INC

Provider Business Mailing Address
First Line	:	13595 SW 134TH AVE STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4580
Country	:	US
Telephone Number	:	305-385-2474
Fax Number	:

Provider Business Practice Location Address
First Line	:	13595 SW 134TH AVE STE 210
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4580
Country	:	US
Telephone Number	:	305-385-2474
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIO A GALVEZ
Credential	:
Telephone Number	:	305-385-2474

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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