Provider Demographics
NPI:1811568959
Name:IC GROUP-MEDICAL LLC
Entity Type:Organization
Organization Name:IC GROUP-MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:AILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-703-9954
Mailing Address - Street 1:2721 SW 137TH AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6319
Mailing Address - Country:US
Mailing Address - Phone:786-703-9954
Mailing Address - Fax:
Practice Address - Street 1:2721 SW 137TH AVE STE 117
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6319
Practice Address - Country:US
Practice Address - Phone:786-703-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care