Healthcare Provider Details

I. General information

NPI: 1518200823
Provider Name (Legal Business Name): FCC MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 N STERLING AVE
TAMPA FL
33614-4228
US

IV. Provider business mailing address

PO BOX 144640
CORAL GABLES FL
33114-4640
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-6600
  • Fax:
Mailing address:
  • Phone: 786-441-5660
  • Fax: 786-441-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTA M FIALLO
Title or Position: OPERATIONS EXECUTIVE
Credential:
Phone: 786-441-5660