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General NPI Number Information
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NPI Number | 1962642074
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Entity Type | Organization
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Legal Business Name | S & O MEDICAL GROUP
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 7200 NW 7TH ST 204
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City | MIAMI
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State | FL
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Zip | 33126-2948
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Country | US
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Telephone | 305-262-8158
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 NW 7TH ST 204
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City | MIAMI
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State | FL
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Zip | 33126-2948
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Country | US
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Telephone | 305-262-8158
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JOSE M ZULUETA
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Credential |
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Telephone | 305-262-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | MA 39065
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License Number State | FL
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