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General NPI Number Information
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NPI Number | 1689622904
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Entity Type | Organization
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Legal Business Name | SUPERIOR MEDICAL GROUP, CORP.
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4866 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2102
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Country | US
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Telephone | 305-460-9560
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Fax | 305-460-8985
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Provider Business Mailing Address
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Address Line | 4866 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2102
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Country | US
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Telephone | 305-460-9560
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Fax | 305-460-8985
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Authorized Official
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Title or Position | PRESIDENT
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Name | YIGANIS TERESA SANTANA
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Credential |
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Telephone | 305-460-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | HCC3935
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License Number State | FL
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