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General NPI Number Information
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NPI Number | 1366896904
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA FAMILY MEDICAL CENTER, LLC.
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 7369 SHERIDAN ST STE 100
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City | HOLLYWOOD
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State | FL
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Zip | 33024
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Country | US
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Telephone | 754-837-8870
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Fax | 754-888-9688
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Provider Business Mailing Address
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Address Line | 7369 SHERIDAN ST STE 100
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2776
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Country | US
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Telephone | 754-837-8870
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Fax | 754-888-9688
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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 | DIRECTOR
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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 | 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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME122433
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License Number State | FL
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