Provider Demographics
NPI:1881702306
Name:COMPREHENSIVE MEDICAL MANAGEMENT SERVICES, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL MANAGEMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-8860
Mailing Address - Street 1:3451 COMMERCE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3900
Mailing Address - Country:US
Mailing Address - Phone:305-884-8650
Mailing Address - Fax:305-863-7349
Practice Address - Street 1:3451 COMMERCE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3900
Practice Address - Country:US
Practice Address - Phone:305-884-8650
Practice Address - Fax:305-863-7349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL933332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028936100Medicaid
FL028936100Medicaid