Healthcare Provider Details

I. General information

NPI: 1568866291
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE OF NORTH MIAMI BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4502
US

IV. Provider business mailing address

1131 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4502
US

V. Phone/Fax

Practice location:
  • Phone: 305-749-6039
  • Fax: 786-916-5001
Mailing address:
  • Phone: 305-749-6039
  • Fax: 786-916-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MARCOS CANINO II
Title or Position: OFFICER
Credential:
Phone: 305-749-6039