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General NPI Number Information
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NPI Number | 1568866291
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CARE OF NORTH MIAMI BEACH, LLC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 1131 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4502
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Country | US
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Telephone | 305-749-6039
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Fax | 786-916-5001
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Provider Business Mailing Address
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Address Line | 1131 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4502
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Country | US
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Telephone | 305-749-6039
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Fax | 786-916-5001
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Authorized Official
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Title or Position | OFFICER
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Name | MARCOS CANINO II
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Credential |
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Telephone | 305-749-6039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | FL
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