Provider Demographics
NPI:1518200823
Name:FCC MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:FCC MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-441-5660
Mailing Address - Street 1:PO BOX 144640
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4640
Mailing Address - Country:US
Mailing Address - Phone:786-441-5660
Mailing Address - Fax:786-441-5660
Practice Address - Street 1:7208 N STERLING AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4228
Practice Address - Country:US
Practice Address - Phone:813-932-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty