Provider Demographics
NPI:1538358494
Name:CASA DE CORAZON PA
Entity type:Organization
Organization Name:CASA DE CORAZON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ-CASTRILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-7636
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-856-7636
Mailing Address - Fax:305-858-6950
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-7636
Practice Address - Fax:305-858-6950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7350Medicare PIN