Basic Information
| Provider Information | |||||||||
| NPI: | 1568904746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLAREMEDICA HEALTH GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13400 SW 120TH ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864851005 | ||||||||
| FaxNumber: | 3054000698 | ||||||||
| Practice Location | |||||||||
| Address1: | 13400 SW 120TH ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864851005 | ||||||||
| FaxNumber: | 3054000698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2016 | ||||||||
| LastUpdateDate: | 11/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | PALENZUELA | ||||||||
| AuthorizedOfficialFirstName: | ROBERTO | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7864851005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.