Healthcare Provider Details

I. General information

NPI: 1124394143
Provider Name (Legal Business Name): TOTAL HEALTH MEDICAL CENTER OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 CORAL WAY STE 203
MIAMI FL
33155-2305
US

IV. Provider business mailing address

8415 CORAL WAY STE 203
MIAMI FL
33155-2305
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-9686
  • Fax: 305-269-7966
Mailing address:
  • Phone: 305-265-9686
  • Fax: 305-269-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHOOO5941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006020
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME83960
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME90842
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100850
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100796
License Number StateFL

VIII. Authorized Official

Name: ANTHONY ORLANDO DELACRUZ
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 786-251-7932