Provider Demographics
NPI:1386041408
Name:LCC MEDICAL GROUP, CORP
Entity Type:Organization
Organization Name:LCC MEDICAL GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-403-2221
Mailing Address - Street 1:1150 NW 72ND AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1921
Mailing Address - Country:US
Mailing Address - Phone:305-403-2221
Mailing Address - Fax:305-403-2262
Practice Address - Street 1:1150 NW 72ND AVE STE 620
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:305-403-2221
Practice Address - Fax:305-403-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9311339261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty