Healthcare Provider Details

I. General information

NPI: 1942781505
Provider Name (Legal Business Name): SURAMED HEALTH CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S STATE ROAD 7, STE 109
WELLINGTON FL
33449
US

IV. Provider business mailing address

3319 SR 7 SUITE 109
WELLINGTON FL
33449
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-5437
  • Fax: 561-798-7726
Mailing address:
  • Phone: 561-798-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFONSO J HENRIQUEZ
Title or Position: PEDIATRICS
Credential: MD
Phone: 561-798-5437