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General NPI Number Information
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NPI Number | 1750823894
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Entity Type | Organization
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Legal Business Name | S.O.A.R SPORT MEDICINE LLC
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 7560 RED BUG LAKE RD STE 2010
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-951-5833
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Fax | 888-972-3696
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Provider Business Mailing Address
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Address Line | 7560 RED BUG LAKE RD STE 2014
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City | OVIEDO
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State | FL
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Zip | 32765-6562
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Country | US
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Telephone | 407-951-5833
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Fax | 888-972-3696
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Authorized Official
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Title or Position | MANAGER
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Name | DR. NAGI YOUSSEF
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Credential |
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Telephone | 321-356-1454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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