| Coral Reef Medical Group Llc | |
|
30334 Old Dixie Hwy Homestead FL 33033-3215 | |
| (786) 243-0149 | |
| (786) 234-2612 |
| Full Name | Coral Reef Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 30334 Old Dixie Hwy, Homestead, Florida |
| Authorized Official Name and Position | Robert Blanco (OWNER) |
| Authorized Official Contact | 7862430149 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coral Reef Medical Group Llc 30334 Old Dixie Hwy Homestead FL 33033-3215 Ph: (786) 243-0149 | Coral Reef Medical Group Llc 30334 Old Dixie Hwy Homestead FL 33033-3215 Ph: (786) 243-0149 |
| NPI Number | 1982870143 |
|---|---|
| Provider Enumeration Date | 05/07/2008 |
| Last Update Date | 03/12/2013 |
| Medicare PECOS PAC ID | 5395808885 |
|---|---|
| Medicare Enrollment ID | O20090109000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982870143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ARNP619302 (Florida) | Secondary |
| 207Q00000X | Family Medicine | PA9103866 (Florida) | Secondary |
| 207R00000X | Internal Medicine | ME57421 (Florida) | Primary |
| Provider Name | Antonio E Blanco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336231562 PECOS PAC ID: 4486546306 Enrollment ID: I20040331000018 |
| Provider Name | Denis Nunez Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235534546 PECOS PAC ID: 6901126366 Enrollment ID: I20150526002376 |
| Provider Name | Miguel De Jesus Perez Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003288291 PECOS PAC ID: 7719284223 Enrollment ID: I20160329001405 |
| Provider Name | Anisia M Otero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811313190 PECOS PAC ID: 7214258243 Enrollment ID: I20160802001994 |
| Provider Name | Marino E Corniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194121939 PECOS PAC ID: 5395019251 Enrollment ID: I20170916000422 |
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