NPIMap

Organization Active NPI

Centrum Medical Holding of Boca Raton

  • Internal Medicine Physician
  • Boca Raton, FL
National Provider Identifier
1619786258
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTRUM MEDICAL HOLDING OF BOCA RATON
Practice address
21073 Powerline Rd Ste 35
Boca Raton, FL 33433-2306
Phone
(305) 266-2929
NPI assigned
Jan 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Graciela Vanessa Victorero
Title
Coo
Phone
(305) 266-2929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

21073 Powerline Rd Ste 35
Boca Raton, FL 33433-2306

Mailing address

9250 NW 36TH St Ste 420
Doral, FL 33178-2775
Phone (305) 266-2929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191223002085 FL Part B Supplier - Clinic/Group Practice 8820422991 Receives reassigned benefits from 82 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Miami Gardens, FL; Miami Shores, FL; Miramar, FL; North Miami Beach, FL; Sweetwater, FL; West Palm Beach, FL; Margate, FL…

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory
Tax ID family
Centrum Medical Centers of El Portal LLC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1619786258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 NW 36TH ST STE 420",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331782775",
            "telephone_number": "305-266-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21073 POWERLINE RD STE 35",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334332306",
            "telephone_number": "305-266-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRUM MEDICAL HOLDING OF BOCA RATON",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "VICTORERO",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-266-2929"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.