Provider Demographics
NPI:1275281461
Name:COMPREHENSIVE CLINICAL CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE CLINICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-701-8702
Mailing Address - Street 1:10201 HAMMOCKS BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3783
Mailing Address - Country:US
Mailing Address - Phone:786-701-8702
Mailing Address - Fax:305-397-2669
Practice Address - Street 1:10201 HAMMOCKS BLVD STE 122
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3783
Practice Address - Country:US
Practice Address - Phone:786-701-8702
Practice Address - Fax:305-397-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy