MEDICARE: CORAL MEDICAL CENTER 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
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1114556388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1722 SW 38TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5576
Country	:	US
Telephone Number	:	786-326-2667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 COLONIAL BLVD STE 219
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1026
Country	:	US
Telephone Number	:	786-326-2667
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLAUDIA DEL PINO
Credential	:
Telephone Number	:	786-326-2667

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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