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General NPI Number Information
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NPI Number | 1912371675
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA US MANAGEMENT INC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 6850 CORAL WAY STE 204
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City | MIAMI
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State | FL
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Zip | 33155-1758
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Country | US
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Telephone | 786-773-2558
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Fax | 305-938-5003
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Provider Business Mailing Address
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Address Line | 6850 CORAL WAY STE 204
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City | MIAMI
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State | FL
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Zip | 33155-1758
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Country | US
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Telephone | 786-773-2558
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Fax | 305-938-5003
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS PENALVER
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Credential |
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Telephone | 786-493-5382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC10498
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License Number State | FL
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