Healthcare Provider Details

I. General information

NPI: 1043238496
Provider Name (Legal Business Name): CONTINUCARE MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5643 NW 29TH ST
MARGATE FL
33063-1531
US

IV. Provider business mailing address

6101 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 954-979-6900
  • Fax: 954-970-2561
Mailing address:
  • Phone: 305-500-2114
  • Fax: 305-370-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberHCC 9946
License Number StateFL

VIII. Authorized Official

Name: GEMMA ROSELLO
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-500-2000