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General NPI Number Information
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NPI Number | 1578952644
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Entity Type | Organization
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Legal Business Name | PROSTOCARE OF SOUTH FLORIDA, INC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 8740 SW 183 TER
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City | PALMETTO BAY
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State | FL
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Zip | 33157
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Country | US
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Telephone | 305-725-8293
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Fax |
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Provider Business Mailing Address
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Address Line | 8740 SW 183 TERRACE
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City | PALMETTO BAY
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State | FL
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Zip | 33157
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Country | US
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Telephone | 305-725-8293
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Fax |
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Authorized Official
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Title or Position | PRESIDENT /CEO
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Name | MR. RAUL ALBERTO SANCHEZ
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Credential |
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Telephone | 305-725-8293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 000000
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License Number State | FL
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