| Mangrove Health Provider, Llc | |
|
11373 Sw 211th St Miami FL 33189-2245 | |
| (954) 699-7766 | |
| Not Available |
| Full Name | Mangrove Health Provider, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11373 Sw 211th St, Miami, Florida |
| Authorized Official Name and Position | Elena C Castaneda (CEO) |
| Authorized Official Contact | 3056064603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mangrove Health Provider, Llc 5966 S Dixie Hwy Ste 300 South Miami FL 33143-5177 Ph: (305) 606-4603 | Mangrove Health Provider, Llc 11373 Sw 211th St Miami FL 33189-2245 Ph: (954) 699-7766 |
| NPI Number | 1659132611 |
|---|---|
| Provider Enumeration Date | 01/17/2024 |
| Last Update Date | 06/12/2026 |
| Medicare PECOS PAC ID | 4587102652 |
|---|---|
| Medicare Enrollment ID | O20240820003552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659132611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Andrew J Greenfield |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1205801453 PECOS PAC ID: 0547236614 Enrollment ID: I20040909000585 |
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