Healthcare Provider Details

I. General information

NPI: 1306544242
Provider Name (Legal Business Name): CURITIVA MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9722 SW 184TH ST
CUTLER BAY FL
33157-6987
US

IV. Provider business mailing address

10651 SW 88TH ST STE 102
MIAMI FL
33176-1573
US

V. Phone/Fax

Practice location:
  • Phone: 786-429-3312
  • Fax: 305-275-7066
Mailing address:
  • Phone: 305-586-3125
  • Fax: 305-275-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANELYS M BOMBIBO
Title or Position: PRESIDENT
Credential:
Phone: 305-586-3125