Provider Demographics
NPI:1851820385
Name:CITY MEDICAL GROUP RC
Entity Type:Organization
Organization Name:CITY MEDICAL GROUP RC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-3423
Mailing Address - Street 1:1150 NW 72ND AVE STE 720
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1932
Mailing Address - Country:US
Mailing Address - Phone:786-409-3423
Mailing Address - Fax:786-409-3427
Practice Address - Street 1:1150 NW 72ND AVE STE 720
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1932
Practice Address - Country:US
Practice Address - Phone:786-409-3423
Practice Address - Fax:786-409-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty