Healthcare Provider Details

I. General information

NPI: 1568189728
Provider Name (Legal Business Name): SYNCHRONY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 W UNIVERSITY AVE STE E
GAINESVILLE FL
32607-1635
US

IV. Provider business mailing address

7328 W UNIVERSITY AVE STE E
GAINESVILLE FL
32607-1635
US

V. Phone/Fax

Practice location:
  • Phone: 352-225-3976
  • Fax: 352-554-5092
Mailing address:
  • Phone: 352-225-3976
  • Fax: 352-554-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALVARO RIVERA CABALLERO
Title or Position: CHIEF OPERATIVE OFFICER
Credential:
Phone: 407-267-7446