=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548202724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH FLORIDA CARDIOLOGY GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 11/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 SW 8TH ST SUITE 204B
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-261-6855
-----------------------------------------------------
Fax | 305-261-8187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 166279
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33116-6279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-380-1626
-----------------------------------------------------
Fax | 305-386-1635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTONIO MARQUEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-261-6855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME 7385
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------