MEDICARE: SOUTH FLORIDA SURGICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME91049	FL

General Provider Information

NPI Number	:	1093026981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA SURGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 451050
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33245-1050
Country	:	US
Telephone Number	:	786-375-1055
Fax Number	:	786-245-7650

Provider Business Practice Location Address
First Line	:	351 NW 42ND AVE STE 409
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5689
Country	:	US
Telephone Number	:	305-631-5355
Fax Number	:	305-631-5354

Authorized Official
Title or Position	:	SURGEON
Name	:	DR. ERIC RAUL VALLADARES
Credential	:
Telephone Number	:	786-375-1055

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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