Provider Demographics
NPI:1124394143
Name:TOTAL HEALTH MEDICAL CENTER OF FLORIDA LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH MEDICAL CENTER OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-251-7932
Mailing Address - Street 1:8415 CORAL WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2305
Mailing Address - Country:US
Mailing Address - Phone:305-265-9686
Mailing Address - Fax:305-269-7966
Practice Address - Street 1:8415 CORAL WAY STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2305
Practice Address - Country:US
Practice Address - Phone:305-265-9686
Practice Address - Fax:305-269-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO5941111N00000X
FLCH0006020111N00000X
207Q00000X
ME83960208D00000X
ME90842208D00000X
FLPA9100850363A00000X
FLPA9100796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty