Provider Demographics
NPI:1376861807
Name:CORAL THERAPY AND MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CORAL THERAPY AND MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:D
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:561-697-2904
Mailing Address - Street 1:1509 N MILITARY TRL STE 212
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4765
Mailing Address - Country:US
Mailing Address - Phone:561-697-2904
Mailing Address - Fax:561-697-2906
Practice Address - Street 1:1509 N MILITARY TRL STE 212
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4765
Practice Address - Country:US
Practice Address - Phone:561-697-2904
Practice Address - Fax:561-697-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4496261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service