Healthcare Provider Details

I. General information

NPI: 1780197152
Provider Name (Legal Business Name): COMPLETE CARE MANAGEMENT SERVICES ACO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LAKESIDE DR STE 525
MIRAMAR FL
33027-3288
US

IV. Provider business mailing address

3400 LAKESIDE DR STE 525
MIRAMAR FL
33027-3288
US

V. Phone/Fax

Practice location:
  • Phone: 786-292-4797
  • Fax: 866-317-9048
Mailing address:
  • Phone: 786-292-4797
  • Fax: 866-317-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARIO ARMANDO ESPINO JR.
Title or Position: FOUNDER-COB
Credential:
Phone: 786-395-1165