Provider Demographics
NPI:1285195685
Name:COMPASSIONATE TRAUMA CARE
Entity Type:Organization
Organization Name:COMPASSIONATE TRAUMA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:OTERO DESANTIAGO
Authorized Official - Suffix:III
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-850-1859
Mailing Address - Street 1:9040 NW 26TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2827
Mailing Address - Country:US
Mailing Address - Phone:954-850-1859
Mailing Address - Fax:
Practice Address - Street 1:14411 COMMERCE WAY STE 350
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1600
Practice Address - Country:US
Practice Address - Phone:305-530-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)