Healthcare Provider Details

I. General information

NPI: 1336166859
Provider Name (Legal Business Name): CONTINUCARE MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 N UNIVERSITY DR
TAMARAC FL
33321-2971
US

IV. Provider business mailing address

6101 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-2300
  • Fax:
Mailing address:
  • Phone: 305-500-2009
  • Fax: 305-500-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberHCC 5457
License Number StateFL

VIII. Authorized Official

Name: GEMMA ROSELLO
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-500-2000