| Eastern Medical Group Corp | |
|
8900 Coral Way Suite 202 Miami FL 33165-2075 | |
| (305) 392-0765 | |
| Not Available |
| Full Name | Eastern Medical Group Corp |
|---|---|
| Speciality | General Practice |
| Location | 8900 Coral Way, Miami, Florida |
| Authorized Official Name and Position | Christian Dominguez (PRESIDENT) |
| Authorized Official Contact | 3053920765 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Medical Group Corp 8900 Coral Way Suite 202 Miami FL 33165-2075 Ph: (305) 392-0765 | Eastern Medical Group Corp 8900 Coral Way Suite 202 Miami FL 33165-2075 Ph: (305) 392-0765 |
| NPI Number | 1093241465 |
|---|---|
| Provider Enumeration Date | 05/04/2017 |
| Last Update Date | 09/11/2023 |
| Medicare PECOS PAC ID | 1456623347 |
|---|---|
| Medicare Enrollment ID | O20180726001282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093241465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | HCC11007 (Florida) | Secondary |
| Provider Name | Carlos A Mirabal |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003928201 PECOS PAC ID: 7416916275 Enrollment ID: I20041007000151 |
| Provider Name | Miriam Garcia Portela |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1407865504 PECOS PAC ID: 6406932524 Enrollment ID: I20080328000453 |
| Provider Name | Maria Theresa Villar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639690068 PECOS PAC ID: 8224362041 Enrollment ID: I20190628000301 |
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