Healthcare Provider Details

I. General information

NPI: 1780368761
Provider Name (Legal Business Name): SOUTH BROWARD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17130 ROYAL PALM BLVD
WESTON FL
33326-2311
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-1366
  • Fax: 954-276-0386
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ESTHER SURUJON
Title or Position: CFO MPG, MPC AND UCC
Credential:
Phone: 954-265-6677