Healthcare Provider Details

I. General information

NPI: 1205382835
Provider Name (Legal Business Name): SOUTH HOLLYWOOD PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3389 SHERIDAN STREET SUITE 606
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

3389 SHERIDAN STREET SUITE 606
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-8417
  • Fax:
Mailing address:
  • Phone: 954-399-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT SANCHEZ
Title or Position: CEO
Credential:
Phone: 305-726-1450