Provider Demographics
NPI:1568866291
Name:COMMUNITY HEALTH CARE OF NORTH MIAMI BEACH, LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE OF NORTH MIAMI BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANINO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:305-749-6039
Mailing Address - Street 1:1131 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4502
Mailing Address - Country:US
Mailing Address - Phone:305-749-6039
Mailing Address - Fax:786-916-5001
Practice Address - Street 1:1131 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4502
Practice Address - Country:US
Practice Address - Phone:305-749-6039
Practice Address - Fax:786-916-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty