Provider Demographics
NPI:1982690822
Name:TRAUMA & FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRAUMA & FAMILY MEDICAL CENTER
Other - Org Name:AWAKENINGS COMMUNITY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-860-5727
Mailing Address - Street 1:2281 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3433
Mailing Address - Country:US
Mailing Address - Phone:305-860-5727
Mailing Address - Fax:305-860-9355
Practice Address - Street 1:2281 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3433
Practice Address - Country:US
Practice Address - Phone:305-860-5727
Practice Address - Fax:305-860-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8651261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101464Medicare Oscar/Certification