Provider Demographics
NPI:1275138620
Name:COMPLETE HEALTH OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:COMPLETE HEALTH OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-497-3444
Mailing Address - Street 1:1150 NW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1936
Mailing Address - Country:US
Mailing Address - Phone:786-653-7131
Mailing Address - Fax:786-706-4900
Practice Address - Street 1:1150 NW 72ND AVE STE 640
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1921
Practice Address - Country:US
Practice Address - Phone:786-497-3444
Practice Address - Fax:786-706-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8062OtherLICENSE