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General NPI Number Information
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NPI Number | 1336484484
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Entity Type | Organization
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Legal Business Name | SENIOR MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1855 N CORPORATE LAKES BLVD STE 1
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City | WESTON
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State | FL
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Zip | 33326-3274
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Country | US
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Telephone | 954-659-9690
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Fax | 954-659-9694
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Provider Business Mailing Address
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Address Line | 1000 NW 57TH CT STE 400
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City | MIAMI
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State | FL
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Zip | 33126-3292
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Country | US
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Telephone | 305-649-8100
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Fax | 954-580-8942
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CARLOS DE SOLO
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Credential |
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Telephone | 305-649-8100
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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 | ME47178
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License Number State | FL
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