Provider Demographics
NPI:1609007293
Name:CORAL REEF MEDICAL OF KENDALL LLC
Entity type:Organization
Organization Name:CORAL REEF MEDICAL OF KENDALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-7660
Mailing Address - Street 1:11440 SW 88TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1044
Mailing Address - Country:US
Mailing Address - Phone:305-271-7660
Mailing Address - Fax:305-271-7599
Practice Address - Street 1:11440 SW 88TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1044
Practice Address - Country:US
Practice Address - Phone:305-271-7660
Practice Address - Fax:305-271-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty