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General NPI Number Information
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NPI Number | 1376861807
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Entity Type | Organization
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Legal Business Name | CORAL THERAPY AND MEDICAL CENTER, INC
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 1509 N MILITARY TRL STE 212
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-4765
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Country | US
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Telephone | 561-697-2904
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Fax | 561-697-2906
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Provider Business Mailing Address
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Address Line | 1509 N MILITARY TRL STE 212
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-4765
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Country | US
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Telephone | 561-697-2904
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Fax | 561-697-2906
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAZARO D RODRIGUEZ
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Credential | CH
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Telephone | 561-697-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH4496
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License Number State | FL
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