Healthcare Provider Details

I. General information

NPI: 1528947181
Provider Name (Legal Business Name): SOUTH GROUP YMG CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10675 SW 190TH ST STE 1204
CUTLER BAY FL
33157-7712
US

IV. Provider business mailing address

10675 SW 190TH ST STE 1204
CUTLER BAY FL
33157-7712
US

V. Phone/Fax

Practice location:
  • Phone: 786-434-2810
  • Fax:
Mailing address:
  • Phone: 786-434-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: YUSNIEL GONZALEZ
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 786-434-2810