Provider Demographics
NPI:1679655880
Name:B & C FAMILY HEALTH GROUP
Entity Type:Organization
Organization Name:B & C FAMILY HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUCURULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-822-5896
Mailing Address - Street 1:7761 NW 146TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1559
Mailing Address - Country:US
Mailing Address - Phone:305-822-5896
Mailing Address - Fax:305-822-4260
Practice Address - Street 1:7761 NW 146TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1559
Practice Address - Country:US
Practice Address - Phone:305-822-5896
Practice Address - Fax:305-822-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269313500Medicaid