Healthcare Provider Details

I. General information

NPI: 1366316564
Provider Name (Legal Business Name): SOUTH BROWARD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 PINES BLVD
PEMBROKE PINES FL
33026-4119
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4325
  • Fax: 954-276-0422
Mailing address:
  • Phone: 954-276-5603
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIO SALCEDA-CRUZ
Title or Position: COO MEMORIAL PHYSICIAN GROUP
Credential:
Phone: 954-276-9312