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General NPI Number Information
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NPI Number | 1366932527
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Entity Type | Organization
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Legal Business Name | SJI MEDICAL, P.A.
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 20311 NW 7TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3454
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Country | US
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Telephone | 786-897-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 20311 NW 7TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3454
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Country | US
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Telephone | 786-897-0578
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SERGIO SAN JOSE
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Credential | DO
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Telephone | 786-897-0578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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