=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407253594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE WOMENS CENTER CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2014
-----------------------------------------------------
Last Update Date | 06/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1951 SW 172ND AVE SUITE 301
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-542-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12818 SW 26TH ST
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-542-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICTOR HUGO CANTERO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-542-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME110277
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------