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General NPI Number Information
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NPI Number | 1861779670
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Entity Type | Organization
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Legal Business Name | INTERNIST OF SOUTH FLORIDA
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 1150 CAMPO SANO AVE SUITE 420
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City | CORAL GABLES
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State | FL
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Zip | 33146-1174
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Country | US
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Telephone | 305-663-0088
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Fax | 305-663-1933
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Provider Business Mailing Address
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Address Line | 1150 CAMPO SANO AVENUE SUITE 420
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City | CORAL GABLES
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State | FL
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Zip | 33146
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Country | US
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Telephone | 305-663-0088
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Fax | 305-663-1933
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SANDY DOMINGUEZ
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Credential |
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Telephone | 305-663-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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