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Organization

MEDICAL CORAL WAY CENTER CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARIELA CRUZ (PRESIDENT)
(561) 429-3122
Entity
Organization

Contact information

Practice address
1401 S MILITARY TRL, SUITE C-1, WEST PALM BEACH, FL 33415-5720
(561) 429-3122
(561) 429-3124
Mailing address
1401 S MILITARY TRL, SUITE C, WEST PALM BEACH, FL 33415-5720
(561) 429-3122
(561) 429-3124

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
208D00000X
General Practice Physician
Primary
208VP0000X
Pain Medicine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
HCC4058
HEALTH CARE CLINIC LICENS
FL
Enumeration date
06/17/2006
Last updated
10/01/2009
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