Healthcare Provider Details

I. General information

NPI: 1750793907
Provider Name (Legal Business Name): SOUTHEAST PHYSICIAN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 N KENDALL DR SUITE 211
MIAMI FL
33176-8708
US

IV. Provider business mailing address

10621 N KENDALL DR SUITE 211
MIAMI FL
33176-8708
US

V. Phone/Fax

Practice location:
  • Phone: 305-458-1475
  • Fax: 305-424-2054
Mailing address:
  • Phone: 305-458-1475
  • Fax: 305-424-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. RENE F GOMEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-458-1475