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NPI Code Detail

MEDICARE: SOUTH DADE TRANSITIONAL CARE GROUP LLC

MEDICARE: SOUTH DADE TRANSITIONAL CARE GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033775036
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH DADE TRANSITIONAL CARE GROUP LLC
Provider Business Mailing Address
First Line : PO BOX 165154
Second Line :
City : MIAMI
State : FL
Zip : 33116-5154
Country : US
Telephone Number : 786-882-1919
Fax Number : 786-206-3161
Provider Business Practice Location Address
First Line : 9619 S DIXIE HWY
Second Line :
City : PINECREST
State : FL
Zip : 33156-2804
Country : US
Telephone Number : 786-882-1919
Fax Number : 786-206-3161
Authorized Official
Title or Position : OWNER
Name : ABELARDO CORONA
Credential : MD
Telephone Number : 786-243-8073
Provider Enumeration Date : 05/15/2019
Last Update Date : 01/17/2025

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