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General NPI Number Information
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NPI Number | 1174901524
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Entity Type | Organization
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Legal Business Name | SAWGRASS PRIMARY CARE PARTNERS LLC
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 12651 W SUNRISE BLVD STE 101
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City | SUNRISE
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State | FL
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Zip | 33323-0906
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Country | US
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Telephone | 954-703-5225
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Fax | 954-703-5115
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Provider Business Mailing Address
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Address Line | 12651 W SUNRISE BLVD STE 101
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City | SUNRISE
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State | FL
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Zip | 33323-0906
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Country | US
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Telephone | 954-703-5225
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Fax | 954-703-5115
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Authorized Official
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Title or Position | MNGR
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Name | MR. JONATHAN ELIO DELVALLE
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Credential | PA-C
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Telephone | 305-519-2546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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