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General NPI Number Information
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NPI Number | 1811123367
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Entity Type | Organization
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Legal Business Name | SARASOTA MEN CLINIC INC
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 625 NE 164 ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3623
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Country | US
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Telephone | 941-552-8667
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Fax | 941-552-8668
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Provider Business Mailing Address
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Address Line | 2250 GULF GATE DR STE B
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City | SARASOTA
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State | FL
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Zip | 34231-4838
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Country | US
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Telephone | 941-552-8667
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Fax | 941-552-8668
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHAN CALVO
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Credential |
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Telephone | 305-335-1823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 263631786
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License Number State | FL
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