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General NPI Number Information
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NPI Number | 1497352587
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Entity Type | Organization
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Legal Business Name | CDR HEALTH CARE INC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 313 NORTON DR STE 102
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5965
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Country | US
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Telephone | 850-738-7977
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Fax |
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Provider Business Mailing Address
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Address Line | 11740 SW 80TH ST STE 102
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City | MIAMI
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State | FL
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Zip | 33183-4822
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Country | US
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Telephone | 786-235-8534
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Fax | 786-235-8501
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. TINA VIDAL-DUART
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Credential | N/A
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Telephone | 786-235-8534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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