Healthcare Provider Details

I. General information

NPI: 1457957896
Provider Name (Legal Business Name): SURAMED HEALTH CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEADOWS RD STE 116-118
BOCA RATON FL
33486-2346
US

IV. Provider business mailing address

801 MEADOWS RD STE 118
BOCA RATON FL
33486-2346
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-9615
  • Fax: 561-338-9616
Mailing address:
  • Phone: 561-338-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFONSO J HENRIQUEZ
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 561-338-9615