Healthcare Provider Details

I. General information

NPI: 1366932527
Provider Name (Legal Business Name): SJI MEDICAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 NW 7TH ST
PEMBROKE PINES FL
33029-3454
US

IV. Provider business mailing address

20311 NW 7TH ST
PEMBROKE PINES FL
33029-3454
US

V. Phone/Fax

Practice location:
  • Phone: 786-897-0578
  • Fax:
Mailing address:
  • Phone: 786-897-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGIO SAN JOSE
Title or Position: PRESIDENT
Credential: DO
Phone: 786-897-0578