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General NPI Number Information
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NPI Number | 1336645936
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Entity Type | Organization
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Legal Business Name | SABUCEDO NEPHROLOGY GROUP INC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 6140 SW 70TH ST FL 2
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3419
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Country | US
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Telephone | 305-793-0605
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Fax |
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Provider Business Mailing Address
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Address Line | 690 W PARK DR APT 208
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City | MIAMI
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State | FL
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Zip | 33172-5325
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Country | US
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Telephone | 305-793-0605
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERTO J SABUCEDO
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Credential | MD
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Telephone | 305-793-0605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME117297
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME117297
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License Number State | FL
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