Provider Demographics
NPI:1477917599
Name:COMPREHENSIVE TRAUMA AND TRAUMA CONSULTANTS
Entity Type:Organization
Organization Name:COMPREHENSIVE TRAUMA AND TRAUMA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-688-4178
Mailing Address - Street 1:671 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2522
Mailing Address - Country:US
Mailing Address - Phone:305-688-4178
Mailing Address - Fax:
Practice Address - Street 1:671 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2522
Practice Address - Country:US
Practice Address - Phone:305-688-4178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS4440OtherDO