=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336166859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTINUCARE MEDICAL MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7495 N UNIVERSITY DR
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-722-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6101 BLUE LAGOON DR SUITE 400
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-500-2009
-----------------------------------------------------
Fax | 305-500-2145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | GEMMA ROSELLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-500-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | HCC 5457
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------