Provider Demographics
NPI:1902859879
Name:ERA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ERA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-207-1030
Mailing Address - Street 1:175 FOUNTAINBLEAU BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7018
Mailing Address - Country:US
Mailing Address - Phone:305-207-1030
Mailing Address - Fax:305-207-1080
Practice Address - Street 1:175 FOUNTAINBLEAU BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7018
Practice Address - Country:US
Practice Address - Phone:305-207-1030
Practice Address - Fax:305-207-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty