Healthcare Provider Details

I. General information

NPI: 1316347263
Provider Name (Legal Business Name): SUNCOAST MEDICAL CENTERS OF SW FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 LEE BLVD STE 4
LEHIGH ACRES FL
33936-4852
US

IV. Provider business mailing address

1154 LEE BLVD STE 4
LEHIGH ACRES FL
33936-4852
US

V. Phone/Fax

Practice location:
  • Phone: 347-852-5705
  • Fax:
Mailing address:
  • Phone: 347-852-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME109802
License Number StateFL

VIII. Authorized Official

Name: DR. BALDIR A LOPEZ ACOSTA
Title or Position: MBR
Credential: MD
Phone: 347-852-5705