Healthcare Provider Details

I. General information

NPI: 1013836089
Provider Name (Legal Business Name): LONGWOOD CARDIAC RECOVERY & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 E STATE ROAD 434 UNIT 2045
LONGWOOD FL
32750-5283
US

IV. Provider business mailing address

587 E STATE ROAD 434 UNIT 2045
LONGWOOD FL
32750-5283
US

V. Phone/Fax

Practice location:
  • Phone: 321-317-3825
  • Fax:
Mailing address:
  • Phone: 321-317-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGIO JOSE SEPULVEDA SUNEZ
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: DPT
Phone: 321-317-3825