Healthcare Provider Details

I. General information

NPI: 1114609419
Provider Name (Legal Business Name): CASABLANCA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E 25TH ST
HIALEAH FL
33013-3402
US

IV. Provider business mailing address

840 E 25TH ST
HIALEAH FL
33013-3402
US

V. Phone/Fax

Practice location:
  • Phone: 786-807-7518
  • Fax: 305-402-4919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUSAYMA SANCHEZ
Title or Position: BILLING DIRECTOR
Credential:
Phone: 786-452-3109