Healthcare Provider Details

I. General information

NPI: 1508895624
Provider Name (Legal Business Name): SOUTH FLORIDA NEPHROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 465
HOLLYWOOD FL
33021-5467
US

IV. Provider business mailing address

1150 N 35TH AVE STE 465
HOLLYWOOD FL
33021-5467
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-9008
  • Fax: 954-986-6646
Mailing address:
  • Phone: 954-986-9008
  • Fax: 954-986-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA D NAVARRO
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-986-9008