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General NPI Number Information
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NPI Number | 1700385093
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA CARE CENTER, INC.
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 2025A N DIXIE HWY
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City | POMPANO BEACH
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State | FL
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Zip | 33060-4968
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Country | US
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Telephone | 561-929-4808
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Fax |
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Provider Business Mailing Address
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Address Line | 7435 AVENIDA DEL MAR APT 2806
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City | BOCA RATON
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State | FL
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Zip | 33433-4879
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Country | US
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Telephone | 561-929-4808
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT ASSISTANT
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Name | MARDOCHEE MONESTIME
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Credential |
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Telephone | 786-328-4352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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