Extra Medical Clinic Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

HCC4063 Issued in FL

Legal business name

EXTRA MEDICAL CLINIC INC

Practice address

717 Ponce de Leon Blvd
Suite 205
Coral Gables, FL 33134-2060

Phone

(305) 441-5722

NPI assigned

Jul 29, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mayra V Perez

Title

Owner, President

Phone

(305) 441-5722

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144235094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 PONCE DE LEON BLVD",
            "address_2": "SUITE 205",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331342060",
            "telephone_number": "305-441-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 PONCE DE LEON BLVD",
            "address_2": "SUITE 205",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331342060",
            "telephone_number": "305-441-5722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRA MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER,  PRESIDENT",
        "authorized_official_telephone_number": "305-441-5722",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "HCC4063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Coral Gables, FL
• Providers in Coral Gables, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.