Healthcare Provider Details

I. General information

NPI: 1538185947
Provider Name (Legal Business Name): CORAL PALM MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NW 29TH ST
MIAMI FL
33127-3950
US

IV. Provider business mailing address

24 NW 29TH ST
MIAMI FL
33127-3950
US

V. Phone/Fax

Practice location:
  • Phone: 305-573-1375
  • Fax: 305-573-1379
Mailing address:
  • Phone: 305-573-1375
  • Fax: 305-573-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberHCC7121
License Number StateFL

VIII. Authorized Official

Name: MISS PILAR ESPINA
Title or Position: PRESIDENT
Credential:
Phone: 305-267-7480