Healthcare Provider Details

I. General information

NPI: 1083910632
Provider Name (Legal Business Name): SURAMED HEALTH CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

IV. Provider business mailing address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-7100
  • Fax: 561-275-7199
Mailing address:
  • Phone: 561-275-7100
  • Fax: 561-275-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98652
License Number StateFL

VIII. Authorized Official

Name: DR. ALFONSO J HENRIQUEZ
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 561-275-7100