Organization
GREEN MOUNTAIN MED CON, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIA FUNDORA (PRESIDENT)
(786) 571-2788
Entity
Organization
Contact information
Practice address
8175 NW 12TH ST STE 221, DORAL, FL 33126-1828
(786) 580-4957
(786) 773-5259
Mailing address
7925 NW 12TH ST STE 325, DORAL, FL 33126-1846
(786) 580-4957
(786) 773-5259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
09/14/2020
Last updated
06/24/2025
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