Healthcare Provider Details

I. General information

NPI: 1578231742
Provider Name (Legal Business Name): EL PROJIMO MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 SUNSET STRIP
SUNRISE FL
33313-6106
US

IV. Provider business mailing address

1084 SUNSET STRIP
SUNRISE FL
33313-6106
US

V. Phone/Fax

Practice location:
  • Phone: 646-407-0586
  • Fax:
Mailing address:
  • Phone: 954-225-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GUSTAVO A CORREA
Title or Position: PD
Credential: MD
Phone: 954-225-4454