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CORAL REEF MEDICAL GROUP LLC NPI 1982870143


NPI Information

NPI: 1982870143
Provider Name: CORAL REEF MEDICAL GROUP LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 10D1101281

Address:
30334 OLD DIXIE HWY
HOMESTEAD, FL
ZIP 33033
Phone: (786) 243-0149
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CORAL REEF MEDICAL GROUP LLC is an internal medicine in Homestead, FL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. CORAL REEF MEDICAL GROUP LLC NPI is 1982870143. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

30334 OLD DIXIE HWY
HOMESTEAD, FL
ZIP 33033-215
Phone: (786) 243-0149
Fax: (786) 234-2612

The provider's authorized official is Robert Blanco .
The authorized official title is Owner and has the following contact phone number (786) 243-0149.

The CLIA number assigned to this NPI record is 10D1101281 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/7/2008 and was last updated on 3/12/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineARNP619302FLORIDANo
2207Q00000XFamily MedicinePA9103866FLORIDANo
3207R00000XInternal MedicineME57421FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1BD867MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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