Healthcare Provider Details

I. General information

NPI: 1578918462
Provider Name (Legal Business Name): SBM MEDICAL SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 LUDGATE HILL LN
ORLANDO FL
32828-7921
US

IV. Provider business mailing address

14225 LUDGATE HILL LN
ORLANDO FL
32828-7921
US

V. Phone/Fax

Practice location:
  • Phone: 407-625-6209
  • Fax:
Mailing address:
  • Phone: 407-625-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN G. BELOSO
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-625-6209