Healthcare Provider Details

I. General information

NPI: 1386411791
Provider Name (Legal Business Name): MED MANAGEMENT OF SFL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 PROSPERITY FARMS RD STE 101B
PALM BEACH GARDENS FL
33410-3462
US

IV. Provider business mailing address

11000 PROSPERITY FARMS RD STE 101
PALM BEACH GARDENS FL
33410-3470
US

V. Phone/Fax

Practice location:
  • Phone: 561-291-6833
  • Fax:
Mailing address:
  • Phone: 561-291-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS DAVID MARINO
Title or Position: CEO
Credential:
Phone: 561-291-6833