Organization · NPI-2

California Club Medical Center LLC

Family Medicine · North Miami Beach, FL

NPI number1538106919
StatusActive
Last updated in NPPESJul 31, 2008

Details

NPI
1538106919
Entity type
Organization (NPI-2)
Legal business name
California Club Medical Center LLC
Organization subpart
No
Enumeration date
Jun 2, 2006
Last updated
Jul 31, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineHCC6244FLYes
207Q00000X Family Medicine–FL

Practice location

850 Ives Dairy Road
Unit 14
North Miami Beach, FL 33179

Phone 305-405-0365 · Fax 305-405-0370

Mailing address

850 Ives Dairy Road
Unit 14
North Miami Beach, FL 33179

Phone 305-405-0365 · Fax 305-405-0370

Authorized official

Mark Grnja
Cfo
9549293400

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