| Coral Blue Medical Center Llc | |
|
8890 Sw 24th St Ste 214 Miami FL 33165-2060 | |
| (786) 641-5100 | |
| (786) 456-5350 |
| Full Name | Coral Blue Medical Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8890 Sw 24th St Ste 214, Miami, Florida |
| Authorized Official Name and Position | Omar Izquierdo (OWNER) |
| Authorized Official Contact | 7866415100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coral Blue Medical Center Llc 8890 Sw 24th St Ste 214 Miami FL 33165-2060 Ph: (786) 641-5100 | Coral Blue Medical Center Llc 8890 Sw 24th St Ste 214 Miami FL 33165-2060 Ph: (786) 641-5100 |
| NPI Number | 1639641392 |
|---|---|
| Provider Enumeration Date | 12/19/2018 |
| Last Update Date | 12/19/2018 |
| Medicare PECOS PAC ID | 6901262930 |
|---|---|
| Medicare Enrollment ID | O20230517003666 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639641392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Patricia Freire |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1740231075 PECOS PAC ID: 5193621845 Enrollment ID: I20031211000891 |
| Provider Name | Yolanda Burgos Zarate |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003036880 PECOS PAC ID: 9436248382 Enrollment ID: I20071130000260 |
| Provider Name | Ricardo O Grinbank |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750422572 PECOS PAC ID: 5698931962 Enrollment ID: I20120801000136 |
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