Healthcare Provider Details

I. General information

NPI: 1790246148
Provider Name (Legal Business Name): SOUTH FLORIDA SPORTS AND PREVENTIVE MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 SW 29TH ST STE 109
MIRAMAR FL
33027-4715
US

IV. Provider business mailing address

14601 SW 29TH ST STE 109
MIRAMAR FL
33027-4715
US

V. Phone/Fax

Practice location:
  • Phone: 954-800-1991
  • Fax: 808-731-8348
Mailing address:
  • Phone: 954-800-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGIO GUITEAU
Title or Position: PRESIDENT
Credential: MD
Phone: 516-849-0072