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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (FL) INC.

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (FL) 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
1207Q00000XFamily Medicine PhysicianFL
2208D00000XGeneral Practice Physician
3207R00000XInternal Medicine PhysicianFL

Other Identifiers

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

General Provider Information

NPI Number : 1487680252
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE (FL) INC.
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 : 3505 PROGRESS LN
Second Line :
City : SAINT CLOUD
State : FL
Zip : 34769-6519
Country : US
Telephone Number : 407-569-1260
Fax Number : 833-963-0109
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 06/24/2006
Last Update Date : 12/18/2025

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