Healthcare Provider Details

I. General information

NPI: 1386186567
Provider Name (Legal Business Name): CLAREMEDICA MSO, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 05/01/2023
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

IV. Provider business mailing address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

V. Phone/Fax

Practice location:
  • Phone: 786-485-1005
  • Fax: 786-441-2156
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MARK LORIN MULLINIX
Title or Position: CEO
Credential:
Phone: 786-758-3135