Healthcare Provider Details

I. General information

NPI: 1336484484
Provider Name (Legal Business Name): SENIOR MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N CORPORATE LAKES BLVD STE 1
WESTON FL
33326-3274
US

IV. Provider business mailing address

1000 NW 57TH CT STE 400
MIAMI FL
33126-3292
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-9690
  • Fax: 954-659-9694
Mailing address:
  • Phone: 305-649-8100
  • Fax: 954-580-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME47178
License Number StateFL

VIII. Authorized Official

Name: CARLOS DE SOLO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-649-8100