Healthcare Provider Details

I. General information

NPI: 1942563374
Provider Name (Legal Business Name): CPC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 SW 27TH AVE #100
MIAMI FL
33145-3663
US

IV. Provider business mailing address

2455 SW 27TH AVE #100
MIAMI FL
33145-3663
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-6661
  • Fax:
Mailing address:
  • Phone: 305-854-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CHERVONY
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-854-6661