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General NPI Number Information
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NPI Number | 1831611003
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA ELITE MD GROUP, INC.
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1861 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3825
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Country | US
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Telephone | 954-513-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 1861 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3825
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Country | US
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Telephone | 954-513-3311
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORBERTO PEDROSO
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Credential | MD
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Telephone | 954-513-3311
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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 | ME100918
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License Number State | FL
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