Healthcare Provider Details

I. General information

NPI: 1588145445
Provider Name (Legal Business Name): SGL MEDICAL CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 NW 7TH ST STE 201
MIAMI FL
33126-5552
US

IV. Provider business mailing address

3939 NW 7TH ST STE 201
MIAMI FL
33126-5552
US

V. Phone/Fax

Practice location:
  • Phone: 786-391-0232
  • Fax: 786-391-0194
Mailing address:
  • Phone: 786-391-0232
  • Fax: 786-391-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11464
License Number StateFL

VIII. Authorized Official

Name: ROXANA LOPEZ PEREZ
Title or Position: OWNER
Credential:
Phone: 786-391-0232