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General NPI Number Information
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NPI Number | 1386041408
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Entity Type | Organization
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Legal Business Name | LCC MEDICAL GROUP, CORP
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 1150 NW 72ND AVE STE 620
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City | MIAMI
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State | FL
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Zip | 33126-1921
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Country | US
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Telephone | 305-403-2221
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Fax | 305-403-2262
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Provider Business Mailing Address
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Address Line | 1150 NW 72ND AVE STE 620
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City | MIAMI
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State | FL
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Zip | 33126-1921
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Country | US
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Telephone | 305-403-2221
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Fax | 305-403-2262
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. VIVIAN SALINAS
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Credential | ARNP
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Telephone | 305-403-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9311339
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP9311339
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License Number State | FL
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