Healthcare Provider Details

I. General information

NPI: 1457480691
Provider Name (Legal Business Name): SOUTH FLORIDA MEDICAL CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 W. SUNRISEBLVD UNIT 207
SUNRISE FL
33323
US

IV. Provider business mailing address

14201 W SUNRISE BLVD UNIT 207
SUNRISE FL
33323-3207
US

V. Phone/Fax

Practice location:
  • Phone: 954-505-5000
  • Fax: 954-756-4442
Mailing address:
  • Phone: 954-505-5000
  • Fax: 754-200-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberHCC9561
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberHC9560
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 954-505-5000