MEDICARE: SOUTH FLORIDA SPORTS AND PREVENTIVE MEDICINE INC

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	261QP2300X	Primary Care Clinic/Center
2	261QM2500X	Medical Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790246148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA SPORTS AND PREVENTIVE MEDICINE INC

Provider Business Mailing Address
First Line	:	14601 SW 29TH ST STE 109
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4715
Country	:	US
Telephone Number	:	954-800-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	14601 SW 29TH ST STE 109
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4715
Country	:	US
Telephone Number	:	954-800-1991
Fax Number	:	808-731-8348

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERGIO GUITEAU
Credential	:	MD
Telephone Number	:	516-849-0072

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	07/11/2023

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