Healthcare Provider Details

I. General information

NPI: 1912371675
Provider Name (Legal Business Name): SOUTH FLORIDA US MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 CORAL WAY STE 204
MIAMI FL
33155-1758
US

IV. Provider business mailing address

6850 CORAL WAY STE 204
MIAMI FL
33155-1758
US

V. Phone/Fax

Practice location:
  • Phone: 786-773-2558
  • Fax: 305-938-5003
Mailing address:
  • Phone: 786-773-2558
  • Fax: 305-938-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC10498
License Number StateFL

VIII. Authorized Official

Name: CARLOS PENALVER
Title or Position: PRESIDENT
Credential:
Phone: 786-493-5382