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General NPI Number Information
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NPI Number | 1821243023
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Entity Type | Organization
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Legal Business Name | SOUTH RESEARCH MEDICAL INC
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 17250 SW 137TH AVE STE B
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City | MIAMI
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State | FL
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Zip | 33177-6405
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Country | US
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Telephone | 786-488-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 17250 SW 137TH AVE STE B
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City | MIAMI
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State | FL
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Zip | 33177-6405
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Country | US
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Telephone | 786-488-0244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOCIS NUNEZ
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Credential |
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Telephone | 786-488-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME51845
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License Number State | FL
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