Healthcare Provider Details

I. General information

NPI: 1376550392
Provider Name (Legal Business Name): SOUTH BROWARD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 490
HOLLYWOOD FL
33021-5423
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3437
  • Fax: 954-265-3731
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ESTHER SURUJON
Title or Position: CFO, MEMORIAL PHYSICIAN GROUP & SBC
Credential:
Phone: 954-265-6677