MEDICARE: FAITH MEDICAL GROUP OF SOUTH FLORIDA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1467307900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH MEDICAL GROUP OF SOUTH FLORIDA

Provider Business Mailing Address
First Line	:	13855 SW 160TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13855 SW 160TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-1937
Country	:	US
Telephone Number	:	786-479-5058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NEYMA PEREZ SUAREZ
Credential	:	APRN
Telephone Number	:	786-479-5058

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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