Organization
CORAL REEF MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BLANCO (OWNER)
(786) 243-0149
Entity
Organization
Contact information
Practice address
30334 OLD DIXIE HWY, HOMESTEAD, FL 33033-3215
(786) 243-0149
(786) 234-2612
Mailing address
30334 OLD DIXIE HWY, HOMESTEAD, FL 33033-3215
(786) 243-0149
(786) 234-2612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ARNP619302
FL
207Q00000X
Family Medicine Physician
PA9103866
FL
207R00000X
Internal Medicine Physician
Primary
ME57421
FL
Other
Enumeration date
05/07/2008
Last updated
03/12/2013
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