Provider Demographics
NPI:1265494553
Name:CORAL VIEW SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CORAL VIEW SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARADELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-8763
Mailing Address - Street 1:8390 W FLAGLER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2039
Mailing Address - Country:US
Mailing Address - Phone:305-551-8763
Mailing Address - Fax:305-221-9066
Practice Address - Street 1:8390 W FLAGLER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2039
Practice Address - Country:US
Practice Address - Phone:305-551-8763
Practice Address - Fax:305-221-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL874261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079087700Medicaid
FL079087700Medicaid