MEDICARE: CLINIC CENTER INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1174555411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC CENTER INC

Provider Business Mailing Address
First Line	:	3800 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4126
Country	:	US
Telephone Number	:	305-557-7777
Fax Number	:	305-557-6352

Provider Business Practice Location Address
First Line	:	3800 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4126
Country	:	US
Telephone Number	:	305-557-7777
Fax Number	:	305-557-6352

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANIBAL PEREZ DE GRACIA
Credential	:
Telephone Number	:	305-557-7777

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/16/2013

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Directions to “CLINIC CENTER INC ” Practice Location

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