Provider Demographics
NPI:1225518905
Name:CLINICAL MANAGEMENT GROUP
Entity Type:Organization
Organization Name:CLINICAL MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZUGARAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-355-8027
Mailing Address - Street 1:12317 SW 20TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7710
Mailing Address - Country:US
Mailing Address - Phone:786-355-8027
Mailing Address - Fax:
Practice Address - Street 1:10550 NW 77 COURT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDEN
Practice Address - State:FL
Practice Address - Zip Code:33016-7084
Practice Address - Country:US
Practice Address - Phone:305-826-3072
Practice Address - Fax:305-826-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty