Healthcare Provider Details

I. General information

NPI: 1366085821
Provider Name (Legal Business Name): COMMUNITY CARE RESOURCES OF FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2555
US

IV. Provider business mailing address

15800 PINES BLVD STE 332
PEMBROKE PINES FL
33027-1212
US

V. Phone/Fax

Practice location:
  • Phone: 407-401-7457
  • Fax: 407-598-0885
Mailing address:
  • Phone: 954-362-5432
  • Fax: 866-240-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FANCISCO URTEAGA
Title or Position: PRESIDENT
Credential:
Phone: 407-401-7457