Healthcare Provider Details

I. General information

NPI: 1184126252
Provider Name (Legal Business Name): TRC MEDICAL PRACTICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 DEL PRADO BLVD S STE 3
CAPE CORAL FL
33904-7263
US

IV. Provider business mailing address

8485 BIRD RD STE 305
MIAMI FL
33155-3262
US

V. Phone/Fax

Practice location:
  • Phone: 239-230-2490
  • Fax: 239-984-8859
Mailing address:
  • Phone: 786-294-0811
  • Fax: 786-362-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCOS AGUILERA
Title or Position: PRESIDENT
Credential:
Phone: 239-230-2490