Healthcare Provider Details

I. General information

NPI: 1235974916
Provider Name (Legal Business Name): SOUTH HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5068 ANNUNCIATION CIR UNIT 111
AVE MARIA FL
34142-9668
US

IV. Provider business mailing address

5068 ANNUNCIATION CIR UNIT 111
AVE MARIA FL
34142-9668
US

V. Phone/Fax

Practice location:
  • Phone: 239-867-4395
  • Fax: 844-735-8444
Mailing address:
  • Phone: 239-867-4395
  • Fax: 844-735-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERWING XAVIER MARTINEZ
Title or Position: OWNER
Credential:
Phone: 305-418-0580