Healthcare Provider Details

I. General information

NPI: 1215308853
Provider Name (Legal Business Name): S U R DOCTORS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE SUITE 304
PALM SPRINGS FL
33461-2500
US

IV. Provider business mailing address

3175 S CONGRESS AVE SUITE 304
PALM SPRINGS FL
33461-2500
US

V. Phone/Fax

Practice location:
  • Phone: 561-598-4864
  • Fax:
Mailing address:
  • Phone: 561-598-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN R RODRIGUEZ
Title or Position: OWNER/ CEO
Credential:
Phone: 561-503-8661