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General NPI Number Information
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NPI Number | 1326582842
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Entity Type | Organization
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Legal Business Name | OUR MEDICAL COMMUNITY CENTER LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 6850 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33155-1758
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Country | US
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Telephone | 305-576-9999
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Fax | 786-615-5608
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Provider Business Mailing Address
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Address Line | 6850 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33155-1758
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Country | US
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Telephone | 305-576-9999
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Fax | 786-615-5608
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | MR. JOSEPH CASTRANOVA III
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Credential | AGENT
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Telephone | 305-576-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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