Provider Demographics
NPI:1184017550
Name:C & C MEDICAL INC
Entity Type:Organization
Organization Name:C & C MEDICAL INC
Other - Org Name:C & C MEDICAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA 51138
Authorized Official - Phone:305-303-8681
Mailing Address - Street 1:13850 SW 143RD CT
Mailing Address - Street 2:STE 18
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6120
Mailing Address - Country:US
Mailing Address - Phone:305-303-8681
Mailing Address - Fax:
Practice Address - Street 1:13850 SW 143RD CT
Practice Address - Street 2:STE 18
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6120
Practice Address - Country:US
Practice Address - Phone:305-303-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty