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General NPI Number Information
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NPI Number | 1073701074
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE CENTER OF MIAMI INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 1301 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33134-3324
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Country | US
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Telephone | 305-443-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33134-3324
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Country | US
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Telephone | 305-443-1743
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LIZBETH MENDOZA
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Credential | MD,PA,FAAFP
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Telephone | 305-446-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0080663
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License Number State | FL
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