Provider Demographics
NPI:1841394160
Name:COMPREHENSIVE CARE AT THE LAKES
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE AT THE LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-924-7788
Mailing Address - Street 1:485 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476-2405
Mailing Address - Country:US
Mailing Address - Phone:561-924-7788
Mailing Address - Fax:561-924-7790
Practice Address - Street 1:485 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-2405
Practice Address - Country:US
Practice Address - Phone:561-924-7788
Practice Address - Fax:561-924-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5665Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER