Basic Information
Provider Information | |||||||||
NPI: | 1689934648 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AMERICAN CARE OF TAMPA, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12171 SW 268TH ST | ||||||||
Address2: |   | ||||||||
City: | HOMESTEAD | ||||||||
State: | FL | ||||||||
PostalCode: | 330328001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052780200 | ||||||||
FaxNumber: | 3058514110 | ||||||||
Practice Location | |||||||||
Address1: | 2775 LAKE ALFRED RD | ||||||||
Address2: |   | ||||||||
City: | WINTER HAVEN | ||||||||
State: | FL | ||||||||
PostalCode: | 338811432 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8632914590 | ||||||||
FaxNumber: | 8635086503 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/24/2012 | ||||||||
LastUpdateDate: | 06/30/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GARCIA | ||||||||
AuthorizedOfficialFirstName: | JOSE | ||||||||
AuthorizedOfficialMiddleName: | EMILLO | ||||||||
AuthorizedOfficialTitleorPosition: | CEO-PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3052780200 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 06/30/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME53888 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.