Provider Demographics
NPI:1457640591
Name:CORAL GABLES PHYSICIAN CARE LLC
Entity Type:Organization
Organization Name:CORAL GABLES PHYSICIAN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-444-1110
Mailing Address - Street 1:3301 SW 22ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2200
Mailing Address - Country:US
Mailing Address - Phone:305-444-1110
Mailing Address - Fax:305-444-1120
Practice Address - Street 1:3301 SW 22ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2200
Practice Address - Country:US
Practice Address - Phone:305-444-1110
Practice Address - Fax:305-444-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty