MEDICARE: CERTIFIED MEDICAL CARE 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	:	1396799839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED MEDICAL CARE INC

Provider Business Mailing Address
First Line	:	721 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	305-637-6634
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 NW 29TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3828
Country	:	US
Telephone Number	:	305-637-6634
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHANIE LEYVA
Credential	:
Telephone Number	:	305-637-6634

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/05/2007

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Directions to “CERTIFIED MEDICAL CARE INC ” Practice Location

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