| Green Mountain Med Con, Inc | |
|
8175 Nw 12th St Ste 221 Doral FL 33126-1828 | |
| (786) 580-4957 | |
| (786) 773-5259 |
| Full Name | Green Mountain Med Con, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 8175 Nw 12th St Ste 221, Doral, Florida |
| Authorized Official Name and Position | Claudia Fundora (PRESIDENT) |
| Authorized Official Contact | 7865712788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Mountain Med Con, Inc 8175 Nw 12th St Ste 221 Doral FL 33126-1828 Ph: (786) 580-4957 | Green Mountain Med Con, Inc 8175 Nw 12th St Ste 221 Doral FL 33126-1828 Ph: (786) 580-4957 |
| NPI Number | 1194330340 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 09/03/2026 |
| Certification Date | 09/03/2026 |
| Medicare PECOS PAC ID | 2264811868 |
|---|---|
| Medicare Enrollment ID | O20220627003577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194330340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | () | Secondary |
| Provider Name | Sara N Llerena |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1487667994 PECOS PAC ID: 1153392600 Enrollment ID: I20040806000207 |
| Provider Name | Yanet Diaz-martell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578024600 PECOS PAC ID: 3971984667 Enrollment ID: I20220712003247 |
| Provider Name | Sandra Rua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962026278 PECOS PAC ID: 5395121578 Enrollment ID: I20220927000546 |
| Provider Name | Liliana D Acosta Cabadilla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750089074 PECOS PAC ID: 3274057310 Enrollment ID: I20250409003868 |
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