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General NPI Number Information
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NPI Number | 1003683020
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA RENAL CARE, LLC.
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 8057 NW 155TH ST
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5874
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Country | US
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Telephone | 305-698-2200
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Fax | 305-698-2243
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Provider Business Mailing Address
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Address Line | 1960 TATNALL SQ APT 205
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City | VERO BEACH
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State | FL
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Zip | 32966-8111
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Country | US
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Telephone | 772-559-1309
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | JORGE GARCIA
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Credential |
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Telephone | 305-606-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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