Provider Demographics
NPI:1154994929
Name:ANGEL CMH CORP
Entity type:Organization
Organization Name:ANGEL CMH CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-822-7270
Mailing Address - Street 1:17325 NW 27TH AVE # 206-207
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4056
Mailing Address - Country:US
Mailing Address - Phone:786-822-7270
Mailing Address - Fax:786-822-7271
Practice Address - Street 1:17325 NW 27TH AVE # 206-207
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4056
Practice Address - Country:US
Practice Address - Phone:786-822-7270
Practice Address - Fax:786-822-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty