Healthcare Provider Details

I. General information

NPI: 1619498946
Provider Name (Legal Business Name): TRAUMA AND CRITICAL CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

2006 NE 49TH ST
FORT LAUDERDALE FL
33308-4524
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-0900
  • Fax:
Mailing address:
  • Phone: 954-210-4120
  • Fax: 954-958-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN PUENTE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-491-0900