Provider Demographics
NPI:1063462703
Name:COMPREHENSIVE PRIMARY CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-9900
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-534-4888
Mailing Address - Fax:305-675-2788
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 900
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-534-4888
Practice Address - Fax:305-675-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72605OtherBLUE CROSS BLUE SHIELD
FLK9865Medicare PIN