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General NPI Number Information
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NPI Number | 1619498946
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Entity Type | Organization
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Legal Business Name | TRAUMA AND CRITICAL CARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1600 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2510
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Country | US
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Telephone | 954-491-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 NE 49TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4524
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Country | US
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Telephone | 954-210-4120
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Fax | 954-958-0221
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN PUENTE
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Credential | M.D.
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Telephone | 954-491-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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