Healthcare Provider Details

I. General information

NPI: 1164165676
Provider Name (Legal Business Name): SAN MARCUS SLEEP LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 NW 173RD DR UNIT 1
HIALEAH FL
33015-5110
US

IV. Provider business mailing address

5941 NW 173RD DR UNIT 1
HIALEAH FL
33015-5110
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-6020
  • Fax: 305-701-4101
Mailing address:
  • Phone: 786-953-6020
  • Fax: 305-701-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEATRIZ GONI
Title or Position: SLEEP CENTER MANAGER
Credential:
Phone: 305-987-1515