Organization
COMMUNITY MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELENA ROSELLO (PRESIDENT)
(305) 694-9364
Entity
Organization
Contact information
Practice address
531 E 25TH ST, HIALEAH, FL 33013-3812
(305) 694-9364
(305) 694-9375
Mailing address
531 E 25TH ST, HIALEAH, FL 33013-3812
(305) 694-9364
(305) 694-9375
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME83652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC7234
AHCA LICENSE
FL
Enumeration date
09/22/2006
Last updated
08/22/2020
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