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General NPI Number Information
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NPI Number | 1306589809
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Entity Type | Organization
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Legal Business Name | CCRM FLORIDA LLC
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 19505 BISCAYNE BLVD
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City | MIAMI
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State | FL
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Zip | 33180-2314
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Country | US
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Telephone | 303-885-5762
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Fax |
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Provider Business Mailing Address
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Address Line | 9380 STATION ST
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City | LONE TREE
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State | CO
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Zip | 80124-6831
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Country | US
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Telephone | 303-885-5762
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGED CARE OFFICER
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Name | DIANE RAVECH
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Credential |
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Telephone | 860-305-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0006X
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Taxonomy Name | Ambulatory Fertility Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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