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General NPI Number Information
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NPI Number | 1477917599
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE TRAUMA AND TRAUMA CONSULTANTS
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 671 NW 119TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-2522
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Country | US
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Telephone | 305-688-4178
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Fax |
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Provider Business Mailing Address
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Address Line | 671 NW 119TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-2522
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Country | US
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Telephone | 305-688-4178
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | RUDOLPH MOISE
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Credential | D.O.
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Telephone | 305-688-4178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | FL
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