| NPI | 1346421203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ITA CAMPOS Billing Supervisor 561-585-8183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: FL ME19252) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: FL ME19252) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2008-01-10 |