Provider Demographics
NPI:1215227913
Name:CORALMED CENTER GROUP, INC.
Entity Type:Organization
Organization Name:CORALMED CENTER GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-921-9230
Mailing Address - Street 1:5655 SW 192ND TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3320
Mailing Address - Country:US
Mailing Address - Phone:786-376-1035
Mailing Address - Fax:
Practice Address - Street 1:4178 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4158
Practice Address - Country:US
Practice Address - Phone:305-921-9230
Practice Address - Fax:305-822-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center