Healthcare Provider Details

I. General information

NPI: 1679187744
Provider Name (Legal Business Name): SWCA RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E HALLANDALE BEACH BLVD STE 605
HALLANDALE BEACH FL
33009-4638
US

IV. Provider business mailing address

1250 E HALLANDALE BEACH BLVD STE 605
HALLANDALE BEACH FL
33009-4638
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-8900
  • Fax: 954-457-9118
Mailing address:
  • Phone: 954-456-8900
  • Fax: 954-457-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN GONZALEZ
Title or Position: MD
Credential: MD
Phone: 954-456-8900