Healthcare Provider Details

I. General information

NPI: 1649322934
Provider Name (Legal Business Name): COOMEVA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 1C
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 1C
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-8725
  • Fax: 305-229-8724
Mailing address:
  • Phone: 305-229-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number600482-4
License Number StateFL

VIII. Authorized Official

Name: MR. EDGAR CARRASCAL
Title or Position: PRESIDENT
Credential:
Phone: 305-229-8725