Provider Demographics
NPI:1497034086
Name:CCG OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:CCG OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-255-7310
Mailing Address - Street 1:2901 CORAL HILLS DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4146
Mailing Address - Country:US
Mailing Address - Phone:954-255-7310
Mailing Address - Fax:954-255-7311
Practice Address - Street 1:2901 CORAL HILLS DR
Practice Address - Street 2:SUITE 360
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4146
Practice Address - Country:US
Practice Address - Phone:954-255-7310
Practice Address - Fax:954-255-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty