Healthcare Provider Details

I. General information

NPI: 1477832848
Provider Name (Legal Business Name): FLORIDA CARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 N. STERLING AVENUE
TAMPA FL
33614
US

IV. Provider business mailing address

P.O. BOX 14-4640
CORAL GABLES FL
33114-4640
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-6600
  • Fax: 813-932-6601
Mailing address:
  • Phone: 305-384-7277
  • Fax: 305-443-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME85120
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0070886
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS6179
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME85120
License Number StateFL

VIII. Authorized Official

Name: MR. CARLOS J GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-888-2210