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General NPI Number Information
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NPI Number | 1649896127
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Entity Type | Organization
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Legal Business Name | SURAMED HEALTH CENTER, PA
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 683 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1998
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Country | US
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Telephone | 772-204-2909
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Fax | 772-785-8138
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Provider Business Mailing Address
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Address Line | 683 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1998
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Country | US
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Telephone | 561-275-7100
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Fax | 561-275-7199
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Authorized Official
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Title or Position | PEDIATRICS
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Name | DR. ALFONSO J HENRIQUEZ
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Credential | MD
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Telephone | 772-204-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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