Provider Demographics
NPI:1376218453
Name:DIRECT PRIMARY CARE OF COCONUT GROVE
Entity Type:Organization
Organization Name:DIRECT PRIMARY CARE OF COCONUT GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:305-812-2208
Mailing Address - Street 1:3436 SW 23RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3023
Mailing Address - Country:US
Mailing Address - Phone:305-871-9608
Mailing Address - Fax:305-390-4659
Practice Address - Street 1:3436 SW 23RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3023
Practice Address - Country:US
Practice Address - Phone:305-871-9608
Practice Address - Fax:305-390-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty