Provider Demographics
NPI:1982117982
Name:CARE CENTER MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CARE CENTER MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-631-4336
Mailing Address - Street 1:2121 SW 3RD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129
Mailing Address - Country:US
Mailing Address - Phone:786-631-4336
Mailing Address - Fax:305-631-2806
Practice Address - Street 1:2121 SW 3RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129
Practice Address - Country:US
Practice Address - Phone:786-631-4336
Practice Address - Fax:305-631-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty