Healthcare Provider Details

I. General information

NPI: 1104315803
Provider Name (Legal Business Name): SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 79TH STREET CSWY STE 120
NORTH BAY VILLAGE FL
33141-4197
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 305-726-2177
  • Fax: 305-726-2209
Mailing address:
  • Phone: 305-500-2000
  • 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: ALICIA LEDO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 786-256-9657