Provider Demographics
NPI:1053361527
Name:COMPREHENSIVE MEDICAL CARE CENTER
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-252-2769
Mailing Address - Street 1:P.O. BOX 327360
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332
Mailing Address - Country:US
Mailing Address - Phone:305-949-6700
Mailing Address - Fax:305-949-6773
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 242
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-949-6700
Practice Address - Fax:305-949-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 783042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG61958Medicare UPIN
FLE3261Medicare ID - Type Unspecified