Healthcare Provider Details

I. General information

NPI: 1609832559
Provider Name (Legal Business Name): SOUTH FLORIDA INFECTIOUS DISEASE AND TROPICAL MEDICINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 SUNSET DR STE 103
SOUTH MIAMI FL
33143-5198
US

IV. Provider business mailing address

5975 SUNSET DR STE 103
SOUTH MIAMI FL
33143-5198
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-4044
  • Fax: 305-667-8387
Mailing address:
  • Phone: 305-666-4044
  • Fax: 305-666-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0059704
License Number StateFL

VIII. Authorized Official

Name: JORGE MEJIA
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 56-666-4044